Posterolateral Approach to the Posterior TalusThe posterolateral approach is used to treat pathology of the posterior aspect of the talus and ankle joint. It is well suited for open reduction and internal fixation of posterior talar fractures. Because the patient is prone, however, it is not the approach of choice if other surgery requires an anterior approach. In such cases, it is often better to use either a posteromedial approach or a lateral approach to the fibula. However, this approach provides the best exposure to the posterior aspect of the talus; therefore, on occasion it may be necessary to change the position of the patient on the table halfway through the operation to permit the use of an additional anterior approach.
Position of the Patient
Place the patient prone on the operating table (Fig. 6-1). As always, when the prone position is used, place longitudinal pads under the pelvis and chest so that the center portion of the chest and abdomen is free to move with respiration. Place a sandbag under the ankle so that the ankle joint is plantarflexed during the operation. Finally, exsanguinate the limb and apply a tourniquet to the mid-thigh.
Landmarks and Incision
The lateral malleolus is the subcutaneous distal end of the fibula. The Achilles tendon is easily palpable as it approaches its insertion into the calcaneus. Make a 5-cm longitudinal incision halfway between the posterior border of the lateral malleolus and lateral border of the Achilles tendon. Begin the incision 2 cm proximal to the tip of the fibula and extend it distally (Fig. 17-1).
Internervous Plane
The internervous plane lies between the peroneus brevis muscle (which is supplied by the superficial peroneal nerve) and the flexor hallucis longus muscle (which is supplied by the tibial nerve).
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