β£Anteromedial (Workhorse for Pilon fractures/Talus fractures)Plane β Medial to Anterior tibialisDanger β Long Saphenous Vein and Saphenous nervePosition β SupineIncision β Anterior to Medial malleolusDissection β Skin β Subcut β Identify and protect LSV with Saphenous nerve β Retract Anterior tibialis laterally β Capsulotomyβ£Posterolateral Approach (2nd workhorse)Internervous/intermuscle plane β Between Peroneals (Superficial Peroneal Nerve [SPN]) and Flexor Hallucis Longus (tibial nerve)Danger β Sural nerve (which becomes the lateral dorsal cutaneous nerve)Position β Prone/lateralIncision β Between Tendoachilles and FibulaDissection β Skin β Subcut β Protect sural nerve β Peroneal tendons β Go medial and identify Flexor Hallucis Longus muscle belly and elevate itTo access the fibula, retract peroneals posteriorly.β£Anterolateral (often used as 2nd incision for Talus dual incision approach)Plane βDistally: Between Anterior compartment muscles including Peroneus tertius (Deep Peroneal Nerve) and Peroneus brevis (Superficial Peroneal Nerve)Proximally: Between Extensor Digitorum Longus (DPN) and Peroneus brevis (SPN)Danger β Superficial Peroneal Nerve, Deep Peroneal Nerve, Anterior Tibial ArteryPosition β SupineIncision β Centered on 4th RayDissection β Skin β Subcut β Extensor retinaculum β Anterior compartment muscles retract medially β Extensor Digitorium Brevis elevated and retracted medially β Arthrotomyβ£Anterior Approach (for Total Ankle Replacement)Plane β Between Extensor Hallucis Longus (EHL) and Extensor Digitodium Longus (EDL) (between the 2 βEβs)Danger β Dorsalis pedis Neurovascular Bundle (NVB) between EHL and EDL (proximally NVB is between AT and EHL)Position β SupineIncision β Midline of both malleoliDissection β Skin β Fascia β Identify 2E and NVB β Retract NVB medially β Capsulotomyβ£Posteromedial (To address Mason Malloy type 3 coronal split in Posterior mal)Danger β Tibial Neurovascular bundlePlane = Between Flexor Digitorium Longus and Flexor Hallucis Longus β£Extensile AM Approach (aka Assal approach)Incision β Vertical incision just lateral to tibial crest, at joint line curve medially to 1cm distal to tip of Medial MalleolusPlane β Medial to Anterior tibialisβ£Ankle ArthroscopyDanger β Superficial peroneal nerve (SPN)Position β SupinePortal positionsAnteromedial portal β Just medial to tibialis anterior. First portalAnterolateral Portal β Under direct vision, watch for SPNPosteromedial portalPosterolateral portalπ My fruit isΒ better thanΒ gold, even fine gold, and my yield thanΒ choice silver. Proverbs 8:19