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Medial Approach to the Ankle

- See: Anteromedial Approach

- Discussion:
    - may be used for  frx dislocations of talus, traumatic injuries to ankle joint, and osteochondritis dissecans of the talus;
    - disadvantages: possible to injure the tibial vessels and nerves;
    - incision:
          - centered on malleolus & is made longitudinal or curved distally, depending on the exposure needed;
          - shift incision anteriorly for access to joint;
          - shift posteriorly to expose the back of the tibia;
    - protect saphenous nerve and saphenous vein which lie superficially just anterior to the malleolus;
    - keep dissection on bone in order to protect tibialis posterior tendon, which is easily lacerated during exposure of the posterior aspect of malleolus;
    - tibialis posterior, FDL, neurovascular bundle, & FHL are elevated as group and gently retracted medially or posteriorly;
    - curve the incision just proximal to the medial malleolus, and divide malleolus with an osteotome;
         - preserve the attachment of the deltoid ligament;
         - later replace malleolus and fix it w/ screw;
         - to make replacement easier, drill hole for screw before osteotomy;
    - posterior malleolus is exposed by reflecting capsule and periosteum retracting tendons of tibialis posterior, FDL & FHL muscles along with the neurovascular bundle posteriorly and medially