Abstract
Purpose
Anatomical reduction and fixation of unstable ankle fractures is necessary to prevent post-traumatic arthritis. Malunion of the distal fibula in unstable ankle fractures can lead to late degenerative changes of the ankle. Late reconstruction of the ankle can improve its function and postpone the need for ankle fusion or replacement.
Methods
We discuss three patients who presented with fibular malunion. All developed medial gutter opening, syndesmotic widening, and lateral shift and/or talar tilt. Surgery involved an anteromedial approach to clean the medial gutter, an anterolateral approach to clean the syndesmotic interval, elongation of the fibula by six to eight millimetres and stabilisation with a cervical spine cage and a locked plate.
Results
After one year, all patients had radiologically demonstrated reduction of the talus in the mortise. Improved function was recorded at final follow up. The cage provides several advantages over other fixation methods, including osteoconductive properties, avoiding bone graft donor site morbidity, and the range of sizes allows the surgeon to adjust the amount of elongation.
Conclusions
Using spinal cages to treat malunited fibula fractures has several advantages compared to bone graft and good results can be expected.
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References
Walling AK, Sanders RW (2007) Ankle Fractures. In: Coughlin MJ, Mann RA, Saltzman CL (eds) Surgery of the foot and ankle, 8th edn. Mosby/Elsevier, Philadelphia, pp 1973–2016
Tunturi T, Kemppainen K, Patiala H et al (1983) Importance of anatomical reduction for subjective recovery after ankle fracture. Acta Orthopedica Scand 54(4):641–647
Perera A, Myerson M (2008) Surgical techniques for the reconstruction of malunited ankle fractures. Foot Ankle Clin N Am 13:737–751
Heineck J, Serra A, Haupt C, Rammelt S (2009) Accuracy of corrective osteotomies in fibular malunion: a cadaver model. Foot Ankle Int 30(8):773–777
Saltzman CL, Salamon ML, Blanchard M et al (2005) Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J 25:44–46
Michelsen JD, Ahn UM, Helgemo SL (1996) Motion of the ankle in a simulated supination-external rotation fracture model. J Bone Joint Surg Am 78:1024–1031
Scranton PE, McMaster JH, Kelly E (1976) Dynamic fibular function. Clin Orthop 118:78–81
Thordarson DB, Motamed S, Hedman T, Ebramzadeh E, Bakshian S (1997) The effect of fibular malreduction on contact pressures in an ankle fracture malunion model. J Bone Joint Surg Am 79:1809–1815
Weber BG, Simpson LA (1985) Corrective lengthening osteotomy of the fibula. Clin Orthop Relat Res 199:61–67
Yablon IG, Leach RE (1989) Reconstruction of malunited fractures of the lateral malleolus. J Bone Joint Surg Am 71:521–527
Chao KH, Wu CC, Lee CH, Chu CM, Wu SS (2004) Corrective-elongation osteotomy without bone graft for old ankle fracture with residual diastasis. Foot Ankle Int 25:123–127
Weber D, Friederich NF, Müller W (1998) Lengthening osteotomy of the fibula for post-traumatic malunion. Indications, technique and results. Int Orthop (SICOT) 22:149–152
Chu A, Weiner L (2009) Distal fibula malunion. J Am Acad Orthop Surg 17:220–230
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Brin, Y.S., Palmanovich, E., Massarwe, S. et al. Using a cervical spine cage to reconstruct malunited fibular fractures. International Orthopaedics (SICOT) 37, 447–450 (2013). https://doi.org/10.1007/s00264-012-1745-9
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DOI: https://doi.org/10.1007/s00264-012-1745-9