Lateral approach to Malleolus

ORIF of fibula

ORIF of syndesmosis

percutaneous placement of syndesmosis screws

access to the posterolateral tibia

ORIF of fibula

ORIF of syndesmosis

percutaneous placement of syndesmosis screws

access to the posterolateral tibia

make longitudinal incision along the posterior margin of the fibula (center incision over fracture site)

extend 2 cm distal to the tip of the lateral malleolus (if needed)

elevate skin flaps taking care not to damage the short saphenous vein and sural nerve that runs posterior to the fibula

look for the superficial peroneal nerve crossing from the lateral to anterior compartments (~10 cm proximal to tip of fibula)

longitudinally incise the periosteum of the subcutaneous surface of the fibula

strip off just enough periosteum to expose the fracture site and achieve a reduction

as you extend the incision proximally take care not to damage the superficial peroneal nerve

proximal - may be developed proximally to become continous with the Lateral approach to the fibula

distal - may be extended distally to become continous with

Ollier's lateral approach to the tarsus

Kocher lateral approach to the ankle and tarsus

Lateral approach to the calcaneus

posterior

can access posterolateral tibia for fixation

interval is the peroneal muscles/tendons and flexor hallucis longus

Sural nerve

cutting may lead to formation of a painful neuroma and numbness along the lateral skin of the foot

Short Saphenous vein

Terminal branches of peroneal artery

lie deep to medial surface of distal fibula

can be damaged if dissection does not stay subperiosteal

may form hematoma after removal or tourniquet

Superficial peroneal nerve

crosses from posterior to anterior over the fibular shaft at the proximal end of the incision