J Korean Foot Ankle Soc.  2023 Jun;27(2):75-78. 10.14193/jkfas.2023.27.2.75.

Surgical Treatment of Talar Chondroblastoma via Partial Posterior Medial Malleolar Osteotomy: A Case Report

• Yu OJ
• Suh JS
• Kim HS
• Choi JY

• KMID: 2543005
• DOI: http://doi.org/10.14193/jkfas.2023.27.2.75

Abstract

During bone tumor resection, many cases require medial malleolar osteotomy to achieve adequate access to the operative field. Various osteotomy methods have been developed to address this issue, including oblique, transverse, reverse V-shape, and step-cut osteotomies. However, medial malleolar osteotomy has several drawbacks, such as the excessive disruption of the joint surface, unstable screw fixation when fixing the medial malleolus, and iatrogenic medial ankle joint arthritis due to articular displacement during the reduction of the osteotomy site. In addition, there is a possibility of injury to the posterior tibial artery, tibial nerve, or posterior tibialis tendon if the osteotomy range is too aggressive. Therefore, the authors propose a new osteotomy method, which has shown promising clinical results, namely, partial posterior medial malleolar osteotomy. This method minimizes articular involvement and provides adequate access to the operative field during talar body bone tumor resection.

Keyword

Talus; Bone tumor; Chondroblastoma; Medial malleolar osteotomy; Partial medial malleolar osteotomy

Figure

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  Figure 1 On standing anteroposterior (A) and lateral (B) radiographs, a round, radiolucent intraosseous lesion was detected. Patient’s magnetic resonance imaging (C∼) showed a subchondral tumoral lesion which was low signal intensity in T1-weighted and high signal intensity in T2-weighted images without a communication to joint space.

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  Figure 2 A posterior half of medial malleolus was cut (A) and articular cartilage was exposed with an intact deltoid ligament as a hinge. A tumoral lesion was curetted under a fluoroscopic guidance (B). Two 3.0-mm cannulated screw to secure the osteotomy site were fixed after bone grafting (C, D). post.: posterior, ant.: anterior.

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  Figure 3 (A) Tumor cells consist of mononuclear chondroblasts, some giant cells and chondroid matrix (black arrows) (H&E, ×200). (B) Neoplastic chondroblasts show coffee-bean nuclear shape (white arrows) (H&E, ×400).

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  Figure 4 At postoperative 12 months, patient’s radiographs show the bony union of both bone graft and osteotomy site without a recurrence of chondroblastoma (A: anteroposterior; B: lateral).

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