This approach is used for fracture of the distal tibia in some cases, for ankle fusions, and for treatment of osteochondritis dissecans of the ankle.
With this midline approach, it is possible to go as far medially or laterally as necessary, and the entire anterior aspect of the ankle can be exposed. It is the only approach that provides that view of the ankle.
The approach shows only the anterior aspect of the ankle, so if there is a need to get around the medial or lateral corners, then incisions medially or laterally would be more appropriate with dissection to allow for anterior exposure. This approach also puts the dorsalis pedis artery and deep peroneal nerve at risk.
STRUCTURES AT RISK
The major structures at risk are the dorsalis pedis artery and the peroneal nerve, which typically cross into the foot just lateral to the tibia and go down into the foot between the base of the first and second metatarsal. They need to be retracted either medially or laterally, whichever can be accomplished with minimal tension on those structures.