Reconstruction of ankle malunion: indications and results

Nine patients had reconstructive surgery for ankle malalignment with tibiotalar incongruity. The clinical result was correlated with the roentgenographic appearance at last followup. Fracture malunions involved supination-external rotation in five patients, pronationabduction in two, pronation-extemal rotation in one, and supination-adduction in one. Osteotomy or osteotomy and bone grafting with soft tissue releases was performed in each case, and tibiofibular syndesmosis fixation was used in three. Two patients had good reductions, three fair, and four poor. Talar displacement and tilt could be corrected in six. At followup, five patients had radiologic evidence of arthrosis. Eight have continued worki ng or are i ndependent i? retirement. Timing of the reconstruction is important. Osteotomy for bimalleolar fractures is indicated in a young patient with mild deformity and minimal arthrosis. Reduction of trimalleolar fractures must be accomplished early to be successful. Aggressive treatment of osteochondral defects may enhance results.