Case for small group discussion Ankle malunion Case for small group discussion AOTrauma—Foot & Ankle Module 7: Ankle arthritis Stefan Rammelt, DE

Case description 46-year-old woman 10 weeks after trimalleolar fracture fixation Presents for syndesmotic screw removal Referred for “redislocation” Soft-tissues benign

CT scans

Correction Posterior fragment first via posterolateral approach with the patient prone

Correction Fibular lengthening, varus osteotomy via the existing lateral approach

1-year follow-up, pain free in daily activities

Take-home message Most important—realignment Joint-preserving osteotomy for posttraumatic malunion even with radiographic evidence of arthritis Good long-term results If posttraumatic arthritis develops, secondary fusion/total ankle replacement in a well-aligned, stable ankle is technically easier References: Weber BG. Lengthening osteotomy of the fibula to correct a widened mortice of the ankle after fracture. Int Orthop. 1981;4(4):289–293. Reidsma, II, Nolte PA, Marti RK, Raaymakers EL. Treatment of malunited fractures of the ankle: A long-term follow-up of reconstructive surgery. J Bone Joint Surg Br. 2010 Jan;92(1):66–70. Rammelt S, Marti RK, Zwipp H (2013). Joint-preserving osteotomies of malunited ankle and pilon fractures. Unfallchirurg. 2013 Sep;116(9):789–796. German. Weber BG. Int Orthop. 1981;4:289–293. Reidsma II et al. J Bone Joint Surg Br. 2010;92:66–70. Rammelt S et al. Unfallchirurg. 2013;116:789–79.