Treatment of posttraumatic varus ankle deformity with supramalleolar osteotomy

Supramalleolar osteotomies for correction of posttraumatic varus arthritis in early and mid-stages provide good functional and clinical outcomes. However, the biomechanical behavior of the ankle joint differs from the knee, and therefore correction of the distal TAS angle alone may not provide a physiologic load transfer across the ankle joint. Osseous balancing of an arthritic varus ankle joint may require not only correction of the articular surface angle in the frontal plane but may include a biplanar correction to improve the talar coverage and a fibular osteotomy to restore ankle joint congruency.