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Management of Malunions, Nonunions, and Late Syndesmotic Injuries of the Ankle

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Evaluation and Surgical Management of the Ankle

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Abstract

Malunions and nonunions after ankle fractures can lead to progressive development of deformity due to deviation from normal hindfoot alignment. This results in eccentric loading and abnormal forces on the ankle joint progressing rapidly to symptomatic posttraumatic arthritis. Joint-preserving osteotomies with secondary anatomic reconstruction of the ankle mortise can be performed in carefully selected patients with good bone quality, adequate range of motion, preserved cartilage, and good compliance. Preoperative planning includes astute clinical assessment, weight-bearing radiographs, and CT imaging taking into account all four malleoli as well as tibial plafond impaction, avascular necrosis, and supramalleolar deformities.

Late syndesmotic injury presents with a wide range of sequelae including impingement, subacute, and chronic syndesmotic instability. It is frequently combined with bony malalignment. Individual treatment options include arthroscopic debridement with arthrolysis, ligament reefing, ligamentoplasty, and tibiofibular fusion with bone grafting and correction of any accompanying malleolar malunions. Anatomic correction of malunited syndesmotic avulsions at the anterior and posterior malleolus will frequently restore syndesmotic stability and correct tibiofibular malalignment by restoring the tibial incisura.

In cases of advanced posttraumatic ankle arthritis, corrective ankle fusion, or arthroplasty is indicated.

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Authors and Affiliations

  1. University Center for Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany

    Stefan Rammelt

  2. Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore

    Choon Chiet Hong

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  1. Stefan Rammelt
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  2. Choon Chiet Hong
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Correspondence to Stefan Rammelt .

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Editors and Affiliations

  1. Center for Bone and Joint Disease, Hudson, FL, USA

    Dolfi Herscovici Jr.

  2. Hughston Orthopedic Trauma, Indianapolis, IN, USA

    Jeffrey O. Anglen

  3. Texas Orthopaedic Associates, Dallas, TX, USA

    John S. Early

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Rammelt, S., Hong, C.C. (2023). Management of Malunions, Nonunions, and Late Syndesmotic Injuries of the Ankle. In: Herscovici Jr., D., Anglen, J.O., Early, J.S. (eds) Evaluation and Surgical Management of the Ankle. Springer, Cham. https://doi.org/10.1007/978-3-031-33537-2_18

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