Tae-Keun Ahn1, Young Yi2, Jae-Ho Cho2, Woo-Chun Lee2. 1. Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 463-712, South Korea. E-mail address: ajh329@gmail.com. 2. Department of Orthopaedic Surgery, Seoul Foot and Ankle Center, Seoul Paik Hospital, Inje University, 85, 2-ga, Jeo-dong, Jung-gu, Seoul 100-032, South Korea. E-mail address for Y. Yi: 20vvin@naver.com. E-mail address for J.-H. Cho: hohotoy@nate.com. E-mail address for W.-C. Lee: leewoochun@gmail.com.
Abstract
INTRODUCTION: A patient with medial ankle osteoarthritis and a widened ankle mortise can be treated successfully with an oblique distal tibial osteotomy, without fibular osteotomy, to narrow the mortise and shift the weight-bearing axis to a more normal position. STEP 1 PATIENT POSITIONING AND PREOPERATIVE ASSESSMENT: With the patient under spinal or general anesthesia, check for mortise widening with a valgus stress test. STEP 2 SURGICAL APPROACH: Expose the ankle joint through an anterior approach. STEP 3 CORRECTIVE OSTEOTOMY: Perform an oblique osteotomy of the distal part of the tibia and narrow the widened mortise by shifting the osteotomized fragment. STEP 4 FIXATION AND BONE-GRAFTING: Stabilize the osteotomy site with a locking plate and apply bone graft to the osteotomy site. STEP 5 CLOSURE: Close the soft tissue in layers. RESULTS: Eighteen patients (fifteen female and three male; mean age, fifty-seven years) with symptomatic medial ankle osteoarthritis and mortise widening underwent distal tibial oblique osteotomy without fibular osteotomy between 2008 and 2011.IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: A patient with medial ankle osteoarthritis and a widened ankle mortise can be treated successfully with an oblique distal tibial osteotomy, without fibular osteotomy, to narrow the mortise and shift the weight-bearing axis to a more normal position. STEP 1 PATIENT POSITIONING AND PREOPERATIVE ASSESSMENT: With the patient under spinal or general anesthesia, check for mortise widening with a valgus stress test. STEP 2 SURGICAL APPROACH: Expose the ankle joint through an anterior approach. STEP 3 CORRECTIVE OSTEOTOMY: Perform an oblique osteotomy of the distal part of the tibia and narrow the widened mortise by shifting the osteotomized fragment. STEP 4 FIXATION AND BONE-GRAFTING: Stabilize the osteotomy site with a locking plate and apply bone graft to the osteotomy site. STEP 5 CLOSURE: Close the soft tissue in layers. RESULTS: Eighteen patients (fifteen female and three male; mean age, fifty-seven years) with symptomatic medial ankle osteoarthritis and mortise widening underwent distal tibial oblique osteotomy without fibular osteotomy between 2008 and 2011.IndicationsContraindicationsPitfalls & Challenges.