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Supramalleolar Osteotomy in Patients with Varus Ankle Osteoarthritis

Introduction
Supramalleolar osteotomies have been reported to be effective in the treatment of moderate primary and traumatic osteoarthritis of the ankle joint.


Step 1 Arthroscopic Examination
Perform an arthroscopic examination prior to the osteotomy in every patient to evaluate the status of the articular cartilage of the tibia and talus.


Step 2 Fibular Osteotomy
Bend a seven-hole plate slightly more than the natural contour of the distal part of the fibula, insert screws, and complete the osteotomy.


Step 3 Tibial Osteotomy
Attempt to achieve a tibial-talar angle of 95° (5° of valgus).


Step 4 Fixation and Bone-Grafting of Tibial Osteotomy Site
Apply a seven-hole plate and pack graft into the osteotomy gap.


Step 5 Postoperative Care
After routine wound closure, apply a short leg cast and do not allow weight-bearing for six weeks after surgery.


Results
In our series of sixteen patients with moderate medial ankle osteoarthritis, the mean American Orthopaedic Foot & Ankle Society (AOFAS) score, radiographic stage, and values for all radiographic parameters measured improved significantly after surgery.


What to Watch For
IndicationsContraindicationsPitfalls & Challenges.