Realignment-lengthening osteotomy for malunited distal fibular fracture

El-Rosasy, Mahmoud A.; Ali, Tarek

doi:10.1007/s00264-013-1876-7

Cited by 29 publications

(27 citation statements)

References 19 publications

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“…The treatment of these fractures is challenging [2-5]. It is often difficult to assess the potential risk of surgical complications because of the variations in the clinical findings.…”

Section: Introductionmentioning

confidence: 99%

Treatment of distal tibial fractures with the Ilizarov external fixator - a prospective observational study in 39 consecutive patients

Ramos

Karlsson

Eriksson

et al. 2013

BMC Musculoskelet Disord

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BackgroundThe management of displaced distal tibial fractures is still controversial. The different internal fixation techniques are often burdened by relatively high complication rates. Minimally invasive techniques with ring fixators have been introduced as an alternative allowing immediate reduction and stabilization, avoiding a staged protocol. The aim of this prospective study was to analyze the clinical and radiographic outcome the Ilizarov technique in patients with distal metaphyseal tibial fractures, with or without intra-articular involvement.MethodsThirty-nine consecutive patients with isolated fractures treated with the Ilizarov technique were followed prospectively for one year. Depending on the type of fracture, 4 or 5 rings were used, in some cases with additional foot extension. Unrestricted weight-bearing was allowed in all cases. Pre- and post-operatively conventional radiographs, post-operative pain assessment and complications were evaluated. The function was evaluated clinically and with self-appraisal protocols: EQ-5D, NHP and FAOS.ResultsNo patient developed compartment syndrome or deep venous thrombosis. Pin infections were frequent, but they were mostly superficial and were treated with antibiotics and/or the removal of isolated pins. Two patients required debridement. One of them had a deep infection and developed a residual deformity which was corrected and healed after re-operation. Another patient had a severe residual deformity. The fixator was removed after a median period of 16 weeks (range 11–30). The radiological results were poor in 5 patients but the overall self-appraisal showed satisfactory results in 36 patients.ConclusionsThe Ilizarov method allowed early definitive treatment with a low complication rate and a good clinical outcome.

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“…The treatment of these fractures is challenging [2-5]. It is often difficult to assess the potential risk of surgical complications because of the variations in the clinical findings.…”

Section: Introductionmentioning

confidence: 99%

Treatment of distal tibial fractures with the Ilizarov external fixator - a prospective observational study in 39 consecutive patients

Ramos

Karlsson

Eriksson

et al. 2013

BMC Musculoskelet Disord

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“…We used the MA angles to assess the fibular shortening. This measurement was found to be simpler to utilize technically as well as being more reproducible, as proposed by previous study. The MA angles will increase in value as the fibula shortens.…”

Section: Discussionmentioning

confidence: 57%

“…Although reconstructive surgery for malunited ankle fractures has been reported to be successful in most cases, we found that some malunited ankles in patients with reconstructive surgery had poor postoperative clinical symptoms. Few data are available regarding which characteristics of the malunited ankles predict poor outcome after surgery in terms of function and risk of malunited ankle fracture.…”

Section: Introductionmentioning

confidence: 59%

“…Supramalleolar osteotomies for malleolar malunion have shown relative good results in more than 70% of patients in the majority of mid‐term and long‐term studies. Supramalleolar osteotomy has been used to restore a normal joint in cases of ankle malalignment, and it is effective for the treatment of traumatic moderate ankle osteoarthritis. Joint sparing osteotomies are a valid alternative to ankle fusion or replacement, especially in young patients with only mild signs of posttraumatic arthritis.…”

Section: Introductionmentioning

confidence: 99%

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Realignment Surgery for Malunited Ankle Fracture

Guo

et al. 2017

Orthopaedic Surgery

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Objective: To investigate the characteristics and the results of realignment surgery for the treatment of malunited ankle fracture.Methods: Thirty-three patients with malunited fractures of the ankle who underwent reconstructive surgery at our hospital from January 2010 to January 2014 were reviewed. The tibial anterior surface angle (TAS), the tibiotalar tilt angle (TTA), the malleolar angle (MA), and the tibial lateral surface angle (TLS) were measured. Clinical assessment was performed with use of the American Orthopaedic Foot and Ankle Society (AOFAS) scale and visual analogue scale (VAS) scores, and the osteoarthritis stage was determined radiographically with the modified Takakura classification system. The Wilcoxon matched-pairs test was used to analyze the difference between the preoperative and the postoperative data.Results: The mean follow-up was 36 months (range, 20-60 months). The mean age at the time of realignment surgery was 37.1 years (range, 18-62 years). Compared with preoperation, the TAS at the last follow-up showed a significant increase (88. , P = 0.005). At the last follow-up, the mean AOFAS score was significantly increased compared with the score at preoperation (44.5 AE 13.7 vs. 78.0 AE 8.9, P < 0.01). Significant differences in VAS scores were found at the last follow-up (6.76 AE 1.03 vs. 2.03 AE 1.21, P < 0.01). There was no significant difference in the Takakura grade between the preoperation and the last follow-up. One patient had increased talar tilt postsurgery; the postoperative talar tilt angle of this patient was 20. One patient had progressive ankle osteoarthritis, and was treated by ankle joint distraction.Conclusions: Realignment surgery for a malunited ankle fracture can reduce pain, improve function, and delay ankle arthrodesis or total ankle replacement. Postoperative large talar tilt and advanced stages of ankle arthritis are the risk factors for the surgery.

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“…A number of techniques have been developed for the reconstruction of the fibula, via the correction of the valgus deformity and restoration of the ankle mortise to its correct anatomical shape, which can help to prevent progression to osteoarthritis. The procedures available to correct possible shortening and/or rotation of the fibula include fibularlengthening osteotomy [1]. In fibular-lengthening osteotomy, if there is a malrotation of more than 10°, the classic horizontal Weber and Simpson osteotomy is indicated, while if the rotation is less than 10°, an oblique or Z-shaped osteotomy can be performed [2].…”

Section: Introductionmentioning

confidence: 99%

Fibular-Lengthening Osteotomy in Patient with Progressive Valgus Deformity After an Ankle Fracture

et al. 2020

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Unusual setting of medical care Background: The fibular fracture requires an anatomical reduction. When a malunion occurs, it can lead to a valgus deformity with an opening of the ankle mortise. Case Report: This case deals with a 23-year-old patient with pain and limited movement in the right ankle, caused by a fracture healed in an incorrect position, with shortening of the fibula and progressive displacement of the valgus, after surgery 12 months earlier for an ankle fracture. The patient underwent a corrective procedure consisting of extemporaneous lengthening of the fibula, with interposition of autologous bone graft and fixation using a compression plate. Six months after surgery, the patient did not present pain or limited movement, and was able to return to his habitual sporting activity. Conclusions: Fibular-lengthening osteotomy is a procedure indicated for patients with malunion fracture of the distal fibula, with shortening and progressive valgus deformity. This surgery allows the restoration of the joint surface, reduces stress on the cartilage and prevents the development of arthropathy of the ankle.

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Realignment-lengthening osteotomy for malunited distal fibular fracture

Cited by 29 publications

References 19 publications

Treatment of distal tibial fractures with the Ilizarov external fixator - a prospective observational study in 39 consecutive patients

Treatment of distal tibial fractures with the Ilizarov external fixator - a prospective observational study in 39 consecutive patients

Realignment Surgery for Malunited Ankle Fracture

Fibular-Lengthening Osteotomy in Patient with Progressive Valgus Deformity After an Ankle Fracture

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