Approach to the Medial Side of the Ankle
Arthrodesis of the ankle
Excision or fixation of osteochondral fragments from the medial side of the talus
Removal of loose bodies from the ankle joint
Position of the Patient
Place the patient supine on the operating table. Exsanguinate the limb either by elevating it for 5 minutes or by applying a soft rubber bandage firmly; then inflate a tourniquet. The natural external rotation of the leg exposes the medial malleolus. The pelvis ordinarily does not have to be tilted to improve the exposure (see Fig. 3-1).
Landmark and Incision
Landmark
The medial malleolus is the palpable distal end of the tibia.
Incision
Make a 10-cm longitudinal incision on the medial aspect of the ankle joint, centering it on the tip of the medial malleolus. Begin the incision over the medial surface of the tibia. Below the malleolus, curve it forward onto the medial side of the middle part of the foot (Fig. 4-1).
Internervous Plane
The approach uses no internervous plane. Nevertheless, the surgery is safe because the tibia is subcutaneous and all dissection stays on bone.
 Figure 4-1 Make a 10-cm longitudinal incision on the medial aspect of the ankle joint, with its center over the tip of the medial malleolus. Distally, curve the incision forward onto the medial side of the middle part of the foot. |
 Figure 4-2 Carefully retract the skin flaps to protect the long saphenous vein and the accompanying saphenous nerve. Incise the flexor retinaculum, and make a small incision into the anterior joint capsule. |
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