Realignment-lengthening osteotomy for malunited distal fibular fracture
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Persistent displacement of ankle fractures increases the stresses on the articular cartilage and leads to degenerative arthritis. Correction of the ankle mortise restores the normal ankle biomechanics and should prevent the development of degenerative joint disease.
Seventeen patients were treated for symptomatic ankle joint due to malunited distal fibular fracture. There were eleven male and six female patients. Their ages ranged from 23 to 54 years (median 34 years). The procedure included transverse fibular osteotomy for restoration of the lateral malleolar alignment, acute distraction of the osteotomy to restore the fibular length with interpositional graft and reduction of subluxation of the distal tibio-fibular articulation. Internal fixation of the osteotomy was performed with plate and screws and trans-syndesmotic screws.
Fibular lengthening was performed in all cases and ranged from six to 12 mm (median eight millimetres). The American Orthopaedic Foot and Ankle Society score preoperatively ranged from 40 to 74 (median 60) and at follow up ranged from 50 to 95 (median 79). Progression of ankles arthrosis occurred in one patient leading to ankle arthrodesis as a secondary procedure. Results were satisfactory in 12 cases (70.6 %), and unsatisfactory in five cases (29.4 %) due to stiffness and pain in the ankle joint. The follow-up ranged from 24 to 45 months (median 31 months).
Corrective osteotomy of fibular malunion produces considerable improvement provided that the patient does not have significant degenerative changes before surgery. The use of athrodiastasis of the ankle as a secondary procedure may be of value to improve the outcome.