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

2. Case description 46-year-old woman
10 weeks after trimalleolar fracture fixation
Presents for syndesmotic screw removal
Referred for “redislocation”
Soft-tissues benign

3. CT scans

4. Correction
Posterior fragment first via posterolateral approach with the patient prone

5. Correction
Fibular lengthening, varus osteotomy via the existing lateral approach

6. 1-year follow-up, pain free in daily activities

7. Take-home message Most important—realignment
Joint-preserving osteotomy for posttraumatic malunion even with radiographic evidence of arthritis
Good long-term results
If posttraumatic arthritis develops, secondary fusion/total ankle replacement in a well-aligned, stable ankle is technically easier
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 BG. 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;116:789–79.