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General Orthopaedics

LATE RECONSTRUCTION OF THE MALUNITED ANKLE FRACTURE

Australian Orthopaedic Association Limited (AOA)



Abstract

Deformity correction has become a more common intervention in an attempt to mitigate pain from an arthritic ankle while hopefully preventing progression of intraarticular disease.

Malunion takes the form of angulation, rotation, translation, and length discrepancy, all of which must be measured and addressed by the surgeon. Contact surface area within the ankle joint can decrease up to 40% with angular malalignment, with subsequent increase in contact pressures in the residual joint surface. As the apex of the deformity moves closer to the ankle joint, pressures increase further. There are no rules as to the magnitude of deformity that necessitates correction, but the literature suggests 15 degrees of varus alalignment, 10 degrees of valgus malalignment and 20 mm shift medial to the mechanical axis all should undergo correction.

This lecture will explore: assessment of deformity, methods of correction, and literature results on the impact deformity correction has on ankle arthritis. As a separate issue, we will also address fibula length and the impact that shortening has on creating ankle arthritis and flatfoot.