Can a fibular malunion be corrected by a Z-shaped fibular osteotomy?

Kann eine fibulare Fehlstellung durch eine Z-förmige fibulare Osteotomie korrigiert werden?



The aim of this study was to assess the short-term clinical and radiographic outcomes in patients who underwent realigning Z‑shaped fibular osteotomy.


Between January 2007 and December 2014, 28 patients with a painful fibular malunion underwent a Z-shaped realignment fibular osteotomy. The mean age was 42.2 ± 14.1 years (range 19.1–67.8 years) and the mean follow-up was 7.0 ± 1.7 years (range 4.0–9.7 years), with no loss to follow-up. Weight-bearing radiographs were used to determine the distal fibula alignment based on Weber’s criteria. Degenerative changes of the tibiotalar joint were assessed using the Kellgren-Lawrence scale. Clinical assessment included pain evaluation, measurement of ankle range of motion (ROM), sports activities, and quality of life outcomes.


There were no intraoperative or perioperative complications. No delayed unions or nonunions were observed. One patient had radiographic progression of degenerative changes in the tibiotalar joint. Postoperative complications included removal of hardware (n = 15) and arthroscopic tibiotalar joint debridement (n = 2). At the last follow-up the mean visual analog scale (VAS) decreased from 6.5 ± 1.1 to 2.1 ± 1.1 (p < 0.001),the ROM improved from 39º ± 6º to 45º ± 4.5º (p < 0.001), the short form health survey questionnaire (SF-36) physical and mental outcome scores improved from 49 ± 8 to 84 ± 7 (p < 0.001) and from 61 ± 4 to 83 ± 5 (p < 0.001), respectively.


The Z‑shaped realignment osteotomy of the distal fibula can provide pain relief and functional improvement in the treatment of fibular malunion. Further studies are needed to address long-term outcomes in this patient cohort.



Ziel dieser Studie war die Beurteilung der klinischen und radiographischen Kurzzeitergebnisse von Patienten, bei denen eine Z‑förmige fibulare Korrekturosteotomie durchgeführt wurde.


Zwischen Januar 2007 und Dezember 2014 unterzogen sich 28 Patienten mit einer schmerzhaften fibularen Fehlstellung einer Z‑förmigen Korrekturosteotomie. Das Durchschnittsalter lag bei 42,2 ± 14,1 Jahren (Range: 19,1–67,8 Jahre), und der durchschnittliche Follow-up betrug 7,0 ±1,7 Jahre (Range: 4,0–9,7 Jahre), ohne „loss to follow-up“. Mittels belasteter Röntgenaufnahmen wurde die Ausrichtung der distalen Fibula mittels der Weber-Klassifikation bestimmt. Degenerative Veränderungen des oberen Sprunggelenks wurden mit der Kellgren-Lawrence-Skala bewertet. Die klinische Untersuchung umfasste die Schmerzbeurteilung, die Messung des Bewegungsumfangs (ROM) des Sprunggelenks, sportliche Aktivitäten und die Lebensqualität.


Intra- oder perioperative Komplikationen gab es keine. Es wurde weder eine verzögerte Heilung noch eine Nichtheilung beobachtet. Ein Patient wies eine radiographische Progression degenerativer Veränderungen im oberen Sprunggelenk auf. Postoperative Komplikationen waren die Entfernung von Metallteilen (n = 15) und das arthroskopische Débridement des Sprunggelenks (n = 2). Beim letzten Follow-up sank der mittlere Wert der visuellen Analogskala (VAS) von 6,5 = 1,1 auf 2,1 = 1,1 (p < 0,001), der ROM verbesserte sich von 39 ± 6º auf 45 ± 4,5º (p < 0,001), die Kurzform des Health-Survey-Fragebogens (SF-36) verbesserte sich von 49 ± 8 auf 84 ± 7 (p < 0,001) (körperliches Befinden) bzw. von 61 ± 4 auf 83 ± 5 (p < 0,001) (mentales Befinden).


Die Z‑förmige Korrekturosteotomie des distalen Wadenbeins kann eine Schmerzlinderung und funktionelle Verbesserung bei der Behandlung fibularer Fehlstellungen bewirken. Weitere Studien sind erforderlich, um die langfristigen Ergebnisse in dieser Patientenkohorte zu untersuchen.

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American Orthopaedic Foot and Ankle Society




Level of evidence


Range of motion


Short form health survey questionnaire


Visual analog scale


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Author information




Alexej Barg: surgery, measurements, statistical analysis, manuscript writing; Timothy L. Kahn: measurements, manuscript review; Graham Dekeyser: measurements, manuscript review; Yantarat Sripanich: revision of manuscript, manuscript review; Victor Valderrabano: surgery, manuscript review.

Corresponding author

Correspondence to Alexej Barg MD.

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Conflict of interest

A. Barg, T.L. Kahn, G. Dekeyser, Y. Sripanich and V. Valderrabano declare that they have no competing interests.

Ethical standards

This retrospective study was approved by the institutional review board (University of Basel) with a waiver of informed consent. For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

Additional information

Investigation performed at University of Utah, Salt Lake City, Utah, USA

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Barg, A., Kahn, T.L., Dekeyser, G. et al. Can a fibular malunion be corrected by a Z-shaped fibular osteotomy?. Orthopäde 50, 60–69 (2021).

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  • Surgical procedures, operative
  • Retrospective study
  • Clinical outcome
  • Radiographic outcome
  • Weber’s criteria


  • Chirurgische Eingriffe, operativ
  • Retrospektive Studie
  • Klinisches Outcome
  • Radiographisches Ergebnis
  • Weber-Klassifikation