Fibular lengthening for malunited ankle fractures

Malunited ankle fractures are uncommon. They produce symptoms of persistent pain, joint effusion, limitation of dorsiflexion and eventually lead to ankle arthritis. We feel that correction of the ankle alignment can improve the final outcome and present our results.

From May 2004 to April 2006, seven patients with a malunited fibular fracture aged 25 to 62 years (male:female ratio, 5:2) were treated in our institute. All patients were referred for persistent pain. The delay between injury and the operative intervention was 3 to 16 months. All patients were assessed with a clinical examination, AOFAS ankle hindfoot score and plain radiographs. A transverse fibular osteotomy was made just above the ankle joint and below the tibiofibular syndesmosis. A tricortical iliac bone graft and a lateral fibular plate were applied.

Fibular length and restoration of the ankle mortise was successful in all the cases. All patients showed radiological evidence of bony union on followup. The average AOFAS score was 82 (pain: 31, function: 41, and alignment: 10). Patients were followed up for an average period of 11 (range, 6 to 24) months after the surgery.

We present our early experience with a simpler fibular osteotomy to correct the ankle joint alignment for malunited fibular fractures which was successful at short-term followup.