1. Ankle malunion and arthritis
Case for small group discussion
AOTrauma—Foot & Ankle
Module 7: Ankle arthritis
Stefan Rammelt, DE

2. Case description 52-year-old active plumber
Internal fixation of a malleolar fracture 1 year previously

3. Case description
Presents with pain on walking 2 years after the fracture, 1 year after implant removal

4. Which treatment option would you choose?
Pain medication, orthosis
Corrective osteotomy
Corrective ankle fusion
Total ankle replacement
Decide during surgery

5. Intraoperative findings
Complete cartilage cover despite 1st–2nd degree chondromalacia

6. Principles of correction (BG Weber)
Realignment of the distal fibula
Reestablishing the ankle mortise

7. Correction
Lengthening
Varus shift
Medial translation

8. 2-year follow-up
Continues working full time as a plumber

10. Take-home messages Most important—realignment
Joint-preserving osteotomy for posttraumatic malunion even with radiographic evidence of arthritis
Good long-term results
Simpler fusion/total ankle replacement with well-aligned ankle
References:
Weber BG. Lengthening osteotomy of the fibula to correct a widened mortice of the ankle after fracture. Int Orthop. 1981;4(4):289–293.
Reidsma, II, Nolte PA, Marti RK, Raaymakers EL. Treatment of malunited fractures of the ankle: A long-term follow-up of reconstructive surgery. J Bone Joint Surg Br Jan;92(1):66–70.
Rammelt S, Marti RK, Zwipp H (2013) Joint-preserving osteotomies of malunited ankle and pilon fractures. Unfallchirurg Sep;116(9):789–796. German.
Weber. Int Orthop. 1981;4:289–293.
Reidsma II et al. J Bone Joint Surg Br. 2010;92:66–70.
Rammelt S et al. Unfallchirurg. 2013;116:789–796.