DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20192616

Delayed surgical reconstruction of adult ankle malunion by supramalleolar osteotomy

Everisto A. Opondo

Abstract


Background: Malunion of the ankle fractures is a frequent cause of morbidity. The normal ankle is essential for normal mobility. Ankle malunion is a common cause of chronic pain, posttraumatic arthritis and work related disability. The importance of proper treatment of these injuries cannot be over emphasised. Lateral talar shift of only 1 mm decreases the tibio-talar contact area by 42%. This increases contact pressure stress by 36%. Together with instability this results in chronic pain and arthrosis.

Methods: A retrospective study was designed to review 21 cases reconstructed after several months to many years of neglect prior to this review. The case reports, operative records, X-rays and CT scans of the patients in addition to physical examination findings were analysed.

Results: Good to excellent results were achieved using basic orthopaedic instrument and implants. This technique is an important armamentarium to orthopaedic surgeons in the third world where late presentation of ankle fractures is common and ideal implants are scanty.

Conclusions: Good to excellent radiological and functional outcomes are achievable with proper preoperative planning and corrective supramalleolar osteotomies.


Keywords


Supramalleolar osteotomy, Malunion, Fibula lengthening

Full Text:

PDF

References


Shah N, Sundaram R, Valusamy A, Brathwonte I. Five-year functional outcome analysis of ankle fracture fixation. Injury. 2007;38:1308-12.

Weber B, Simpson L. Corrective Lengthening osteotomy of the fibula. Clin Orthop Related Res. 1985;199:61-7.

Henderson W, Lau J. Reconstruction of failed ankle fractures. Foot Ankle Clin N Am. 2006;1:51-60.

Gregory D, Dickos M, Jason D, Rober H. Choplin M, Weber M. Normal tibio fibular relationship at the syndesmosis on axial CT Imaging. Orthop Trauma. 2012;2:26.

Joerd A, Michel P, Gino M, Beat H, Nierk Van Dijk. Long-term outcome after 1822 operatively treated ankle fracture. A systematic review of the literature. Injury. 2011;42:119-27.

Makwana N, Bohwal B, Harper W, Hui A. Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age:a prospective randomized study. J Bone Joint Surg. 2001;83:523-9.

Sandio G, Cesare F, Francesco A. Surgical treatment of post-traumatic malalignment of the ankle. Injury. 2010:41:1208-11.

Khan WS, Malik AA, Aggarwal M, Dalal R. Delayed open reduction and internal fixation of a neglected fracture dislocation of the ankle. Int J Clin Pract. 2007;61:594-5.

Serder T, Morgan S, David JH. Fixing the almost healed ankle fracture, is surgery reduction and complication rate different from acute open reduction and internal fixation? Current Orthop Pract. 2012;23:1.

Fogel GR, Morrey BF. Delayed open reduction and fixation of ankle fractures. Clin Orthop Relat Res. 1987;215:187-95.

Offierski CM, Graham JD, Hall JH, Harris WR, Schatzker JL. Late revision of fibular malunion in ankle fractures. Clin Orthop Relat Res. 1982;171:145-9.

Olerud C, Molander H. A scoring scale for symptom evaluation after ankle fracture. Arch orthop Trauma Surg. 1984;103:190-4.