Ankle arthrodesis

fibulectomy and screw fixation

· expose the distal fibula through a lataral incision and curve it forward over the subtalar joint

· make an osteotomy in the fibular shaft 8 cm from the tip

· enucleate the distal fibula subperiostially

· protect the peroneal tendons and the superficial peroneal nerve

· spread open the tibiotalar joint

· denude the articular surfaces to subchondral bone

· use the fibula for bone graft

· align the osteotomy and fix it with 2 cancellous screws

· from the lateral cortex into the talus

Position

· 5-7^o of valgus

· plantargrade for men and 10^o plantarflexion for women

· slight posterior displacement of talus

· external rotation to match opposite side

Brostrum procedure

· place in lateral position

· make curvilinear incision under distal border of lateral malleolus

· from sural to superficial peroneal nerves

· open distal part of peroneal retinaculum and retract peroneal tendons inferiorly

· mobilise lateral portion of extensor retinaculum

· identify attenuated ATF and CF

· open capsule along anterior border of fibula

· leave 3 mm cuff on fibula

· inspect tibiotalar and talofibular joints

· for loose bodies and articular damage

· place foot in eversion and abduction

· trim and repair ligaments

· double breasting

· through drillholes

· test ankle for anterior drawer and talar tilt

· pull extensor retinaculum over distal fibula and suture it there

· close wound

· apply cast in eversion