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Posterior Ankle and Hindfoot Arthroscopy

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1 Posterior Ankle and Hindfoot Arthroscopy
by Florian Nickisch, Alexej Barg, Charles L. Saltzman, Timothy C. Beals, Davide E. Bonasia, Phinit Phisitkul, John E. Femino, and Annunziato Amendola JBJS Essent Surg Tech Volume 2(3):e15 July 11, 2012 ©2012 by The Journal of Bone and Joint Surgery, Inc.

2 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

3 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

4 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

5 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

6 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

7 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

8 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

9 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

10 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

11 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

12 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

13 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

14 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

15 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

16 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

17 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

18 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

19 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

20 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

21 The patient is placed prone with the contralateral leg flexed at the knee and attached to a vertical post to stabilize it. The patient is placed prone with the contralateral leg flexed at the knee and attached to a vertical post to stabilize it. Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15 ©2012 by The Journal of Bone and Joint Surgery, Inc.

22 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

23 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

24 The calcaneal traction pin is attached to a sterile traction bow.
Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15 ©2012 by The Journal of Bone and Joint Surgery, Inc.

25 The final position with sterile draping and the mini-c-arm fluoroscopy unit in place.
Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15 ©2012 by The Journal of Bone and Joint Surgery, Inc.

26 Lateral fluoroscopic image demonstrating the amount of distraction achieved after application of calcaneal traction. Lateral fluoroscopic image demonstrating the amount of distraction achieved after application of calcaneal traction. Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15 ©2012 by The Journal of Bone and Joint Surgery, Inc.

27 The positions of the arthroscopy portals are marked at the level of the tip of the lateral malleolus. The positions of the arthroscopy portals are marked at the level of the tip of the lateral malleolus. Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15 ©2012 by The Journal of Bone and Joint Surgery, Inc.

28 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

29 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

30 After making the skin incision, spread the subcutaneous tissue with a straight mosquito clamp.
Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15 ©2012 by The Journal of Bone and Joint Surgery, Inc.

31 Drawing demonstrating placement of the two standard portals (the posteromedial [PM] and posterolateral dorsal [PLD] portals) and an accessory posterolateral portal (the posterolateral ventral [PLV] portal) and their relationship to the neurovascular structu... Drawing demonstrating placement of the two standard portals (the posteromedial [PM] and posterolateral dorsal [PLD] portals) and an accessory posterolateral portal (the posterolateral ventral [PLV] portal) and their relationship to the neurovascular structures. FHL = flexor hallucis longus. Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15 ©2012 by The Journal of Bone and Joint Surgery, Inc.

32 Operative image demonstrating the two standard (posteromedial and posterolateral dorsal) portals and the accessory posterolateral ventral portal (with a blunt trocar). Operative image demonstrating the two standard (posteromedial and posterolateral dorsal) portals and the accessory posterolateral ventral portal (with a blunt trocar). Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15 ©2012 by The Journal of Bone and Joint Surgery, Inc.

33 Arthroscopic view of the posterior facet of the subtalar joint (arrow).
Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15 ©2012 by The Journal of Bone and Joint Surgery, Inc.

34 Arthroscopic view of the posterior facet of the subtalar joint (arrow) after cartilage debridement.
Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15 ©2012 by The Journal of Bone and Joint Surgery, Inc.

35 Allograft (arrow) has been placed through a small funnel prior to screw fixation.
Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15 ©2012 by The Journal of Bone and Joint Surgery, Inc.

36 Postoperative lateral radiograph showing solid fusion six months after posterior arthroscopic subtalar arthrodesis. Postoperative lateral radiograph showing solid fusion six months after posterior arthroscopic subtalar arthrodesis. Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15 ©2012 by The Journal of Bone and Joint Surgery, Inc.

37 The flexor hallucis longus tendon (arrow) is visualized from the posterolateral portal.
Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15 ©2012 by The Journal of Bone and Joint Surgery, Inc.

38 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

39 Florian Nickisch et al. JBJS Essent Surg Tech 2012;2:e15
©2012 by The Journal of Bone and Joint Surgery, Inc.

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