M G Walcher1,2, L Fraissler3, C Konrads3, P Plumhoff3, M Hoberg3, M Rudert3. 1. OCW Orthopädie Chirurgie Würzburg, Oeggstr. 3, 97070, Würzburg, Deutschland. m.walcher@ocwuerzburg.de. 2. Orthopädische Klinik König-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Deutschland. m.walcher@ocwuerzburg.de. 3. Orthopädische Klinik König-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Deutschland.
Abstract
OBJECTIVE: Restoration of physiological alignment of the distal tibia and thereby restoration of physiological loading of the ankle joint; joint preservation in asymmetric degenerative arthritis of the ankle. INDICATIONS: Congenital deformities of the distal tibia; acquired deformities of the distal tibia; asymmetric degenerative arthritis with partially preserved cartilage. CONTRAINDICATIONS: Absolute contraindications comprise severe nicotine abuse, Charcot arthropathy, peripheral polyneuropathy, relevant peripheral arterial vessel disease, poor local soft tissue condition, acute infection and extensive cartilage damage grade 3-4 in the Outerbridge classification in the complete joint. SURGICAL TECHNIQUE: Medial and lateral open and closed wedge osteotomies and dome osteotomies of the distal tibia are used, and shortening, lengthening and derotating osteotomies of the fibula. POSTOPERATIVE MANAGEMENT: For 6 weeks, 15-20 kg partial weight-bearing in a below knee cast or a walker orthosis; full weight-bearing depending on osseous healing after 9-12 weeks postoperatively. RESULTS: Between July 2012 and May 2017, 15 patients (10 men, 5 women) underwent a supramalleor osteotomy. Average age was 41.8 years (range 17-63 years) and the retrospective average follow-up was 28.7 months (range 3-47 months). Mean preoperative AOFAS (American Orthopaedic Foot and Ankle Society) hindfoot score was 54.3 (range 26-86) and postoperatively a mean of 74.2 (44-100). Preoperatively, 9 patients had varus malalignment and 6 patients valgus malalignment; overall, 4 patients developed complications requiring surgical intervention (26.7%). Osteosynthetic material was removed in 60% of the patients.
OBJECTIVE: Restoration of physiological alignment of the distal tibia and thereby restoration of physiological loading of the ankle joint; joint preservation in asymmetric degenerative arthritis of the ankle. INDICATIONS: Congenital deformities of the distal tibia; acquired deformities of the distal tibia; asymmetric degenerative arthritis with partially preserved cartilage. CONTRAINDICATIONS: Absolute contraindications comprise severe nicotine abuse, Charcot arthropathy, peripheral polyneuropathy, relevant peripheral arterial vessel disease, poor local soft tissue condition, acute infection and extensive cartilage damage grade 3-4 in the Outerbridge classification in the complete joint. SURGICAL TECHNIQUE: Medial and lateral open and closed wedge osteotomies and dome osteotomies of the distal tibia are used, and shortening, lengthening and derotating osteotomies of the fibula. POSTOPERATIVE MANAGEMENT: For 6 weeks, 15-20 kg partial weight-bearing in a below knee cast or a walker orthosis; full weight-bearing depending on osseous healing after 9-12 weeks postoperatively. RESULTS: Between July 2012 and May 2017, 15 patients (10 men, 5 women) underwent a supramalleor osteotomy. Average age was 41.8 years (range 17-63 years) and the retrospective average follow-up was 28.7 months (range 3-47 months). Mean preoperative AOFAS (American Orthopaedic Foot and Ankle Society) hindfoot score was 54.3 (range 26-86) and postoperatively a mean of 74.2 (44-100). Preoperatively, 9 patients had varus malalignment and 6 patientsvalgus malalignment; overall, 4 patients developed complications requiring surgical intervention (26.7%). Osteosynthetic material was removed in 60% of the patients.