J Korean Foot Ankle Soc.  2022 Sep;26(3):143-147. 10.14193/jkfas.2022.26.3.143.

A Fibular Lengthening Osteotomy Combined with Calcaneal Osteotomy for Post-Traumatic Valgus Ankle Arthritis: A Case Report

• Lee GH
• Suh JS
• Choi JY

• KMID: 2533197
• DOI: http://doi.org/10.14193/jkfas.2022.26.3.143

Abstract

Past research has reported that the common causes of ankle arthritis include trauma, congenital deformity, and degeneration. Among them, fracture-induced post-traumatic arthritis is most common. For patients with ankle fractures, an anatomical reduction is performed through surgical treatment. However, insufficient reduction or malunion of the fracture site may change the alignment of the ankle joint, resulting in valgus or varus deformities. Currently, most operative options for valgus arthritis aim to either restore joint alignment and/or reduce the uneven load on the cartilage. In this report, we would like to share our clinical experience of a patient with posttraumatic valgus ankle arthritis caused by severely comminuted fracture and dislocation. A satisfactory outcome could be obtained with combined fibular lengthening osteotomy and medial displacement calcaneal osteotomy.

Keyword

Valgus deformity; Posttraumatic arthritis; Fibular shortening; Fibular lengthening osteotomy; Calcaneal osteotomy

Figure

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  Figure 1 (A) The patient had bilateral medial ankle wound with bony exposure. (B) Initial radiographs showed fracture-dislocation of both ankles. (C) We also found bilateral posterior malleolar fractures with 3-dimensional computed radiographs.

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  Figure 2 Bilateral intramedullary Steinmann fixation was performed for severe comminuted lateral malleolar fractures. Posterior malleolar fractures were also fixed with cannulated screws through posterolateral approach. Immediate postoperative radiographs of right (A) and left (B) sides.

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  Figure 3 During the 3-month (A), 6-month (B), and 12-month (C) follow-up, valgus talar tilt gradually increased with relative fibular shortening.

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  Figure 4 At 18 postoperative months (A), valgus ankle arthritis was developed on the left side while the talar tile on the right side was intact. On the hindfoot alignment view (B), valgus malaligned hindfoot was shown. A valgus deformity was corrected on with varus stress (C). A standard load of 150 N was applied to the ankle joint using the Telos device (METAX, Hungen, Germany). Using 3-dimensional computed tomography (D), we found a bony contact with subchondral cyst formation on the lateral side of talar dome and tibial plafond.

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  Figure 5 (A) A Z-shaped osteotomy line for fibular lengthening was drawn on the fibula. (B) A cartilage denuded surface on the lateral talar dome was exposed and multiple drilling was performed. On immediate postoperative anteroposterior (C) and lateral (D) radiographs, we found that a successful talar tilt correction was obtained through the fibular lengthening osteotomy combined with medial displacement calcaneal osteotomy. (E) A calcaneus axial radiograph showed a successful medial displacement (10 cm) of calcaneal tuberosity.

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  Figure 6 (A, B) At postoperative 18 months, talar tilt was changed to 6.9° valgus with an obvious gap between lateral talar dome and tibial plafond. (C) A hindfoot alignment was also corrected to the neutral position.

Reference

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