Malunion after pilon fracture Case for small group discussion AOTrauma—Foot & Ankle Module 7: Ankle arthritis Stefan Rammelt, DE

Case description 47-year-old man Heavy drinker (due to pain) Constant pain and restricted ankle motion 1 year after injury

Preoperative images

Type and timing of correction Observation Corrective fusion Hardware removal, later total ankle replacement Opening wedge osteotomy Closing wedge osteotomy

Site of osteotomy—CORA (center of rotation and angulation) Closing wedge

30° 14° Correction Closing wedge osteotomy Blade plate fixation

4 months after correction Patient full weight bearing immediately against advice Note slide varus shift and medial callus

6.5 years after correction Not drinking anymore No pain during daily activities No longer drinking

Before correction After correction

Function at 6.5 years after correction

Take-home messages Pilon fracture underestimated as “bimalleolar ankle fracture“ Malfunction with extraarticular (metaphyseal) deformity Individual planning Protecting the ankle joint with realignment Good long-term results with corrective osteotomy