Introduction: The posterolateral approach was first described by Gatellier and Chastang in 1924 for assessing fragments of the posterior malleolar bone in ankle fractures. The correct posterior exposure of the distal tibia also makes it possible to treat osteochondritis dissecans of the talus, to excise benign tumors and to perform arthrodesis of the posterior facet of the subtalar joint. The objective of our study was to assess the exposure area of the posterior region of the distal tibia in the posterolateral approach and to determine its safety. Methods: The study was conducted on the fresh cadaver of a 54-year-old man without scars at the site. With the body positioned in dorsal decubitus, we marked the reference points. A 12-cm longitudinal incision was made halfway between the lateral malleolus and the Achilles tendon, extending distally along the posterior border of the fibula toward the fifth metatarsal. The sural nerve follows its course at a constant distance, on average 2.5 cm, posterior to the fibula. After the incision of the peroneal retinaculum sheath was made, the tendons were exposed and moved to the anterior. In the medial region, we moved the Achilles tendon and exposed the flexor hallucis longus tendon, moving it medially and exposing the posterior region of the tibia and syndesmosis. Using a digital caliper (Mitutoyu Kawasaki, Japan), we measured the exposed area. We respected a 40-mm safety area where the fibular artery arises from the bifurcation of the tibial-fibular trunk. We chose not to perform fibular osteotomy or a longitudinal section of the flexor hallucis longus tendon. Results: A 30.44-mm segment was exposed in the transverse plane of the distal tibial region that begins at the posterior distal tibiofibular syndesmosis. Conclusion: The posterolateral approach provides excellent exposure of the distal region of the tibia with great safety. The tibial nerve and the posterior tibial artery are safe after the flexor hallucis longus tendon is moved, and the sural nerve is contained in the region proximal to the approach. The exposed area stretches to the region near the medial malleolus, and the flexor retinaculum prevents a more medial approach. We conclude that the posterolateral approach is safe even for more medial lesions restricted to the flexor retinaculum.

Background: The osteochondral grafting has become a popular procedure for treating challenging talar dome lesions. However, the vast majority are treated through medial malleolus osteotomy. The aim of this study was to determine the posteromedial area of the talus that can be reached without malleolar osteotomy through the posteromedial approach. Study Design: Descriptive laboratory study. Evidence Level 4 Methods: Fifteen human cadaveric ankles were dissected in a standard fashion to expose the posteromedial talar dome. Seven approaches were used on the cadaver's left limb (46.7%). We did not observe any significant difference between the evaluated sides (chi-square test, p = 0.715).  Results: On average, 2,09 cm2 (range, 1,72-2,69) of the posteromedial talus dome or 15,27 % (range 12-20) of total talus dome can be accessed without osteotomy. Conclusion: If the osteochondral lesion is within the area accessible through PM approach (mean 2 cm2), as seen on magnetic resonance imaging, it is possible that it can be treated without a medial malleolus osteotomy. Keywords: talus; osteochondral lesions; osteotomy; arthrotomy; surgery

Objetivo: To evaluate the topographic and morphometric aspects of the sural nerve in cadavers as well as its relationship with the modified Palmer approach.  Methods: Thirty lower limbs of fifteen fresh cadavers were used for dissection of the sural nerve, and 5 measurements were performed using the lateral malleolus and the calcaneal tendon as the repair point. The paired student's T-test was used to compare the averages of the measurements between the sides of the same cadaver. A value of p < 0.05 was considered significant for all analyses.  Results: On average, the sural nerve issued its first branch 40.40 mm above the lateral malleolus, situated on average 13.84 mm posterior to the tip of the lateral malleolus and on average 23.76 mm inferior to the point of the lateral malleolus.  Conclusion: The modified Palmer’s approach was shown to be promising, since it demonstrated lower postoperative complication rates, especially when compared with the extended lateral pathway. The results obtained will aid during the surgical incision, adding safety to the procedure by avoiding injury of branches of the sural nerve.

Peritalar dislocation is a rare injury, usually associated with fractures. It mainly affects males in high-energy traumas such as falls from height, car accidents, or even torsional traumas during the practice of sports activities. This study illustrates a case attended by the authors to discuss peritalar dislocation and its diagnosis, classification, treatment, and prognosis. Such injury may evolve with complications if not properly managed, including ankle movement pain, joint stiffness, deformities, post-traumatic arthrosis, and even osteonecrosis. Level of Evidence V; Therapeutic Studies; Expert Opinion.