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

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

3. Preoperative images

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

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

6. 30°
14°
Correction
Closing wedge osteotomy
Blade plate fixation

7. 4 months after correction
Patient full weight bearing immediately against advice
Note slide varus shift and medial callus

8. 6.5 years after correction
Not drinking anymore
No pain during daily activities
No longer drinking

9. Before correction
After correction

11. Function at 6.5 years after correction

12. 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