[Osteotomies of the distal tibia]

Area of Science:

• Orthopedic Surgery
• Biomechanics
• Reconstructive Surgery

Background:

• Ankle arthritis and deformities significantly impair joint function and quality of life.
• Restoring physiological alignment is crucial for ankle joint preservation and load distribution.

Purpose of the Study:

• To evaluate the efficacy of supramalleolar osteotomy in restoring distal tibial alignment.
• To assess joint preservation and functional outcomes in patients with asymmetric degenerative ankle arthritis.

Main Methods:

• Supramalleolar osteotomies (medial/lateral open/closed wedge, dome) and fibular osteotomies (shortening, lengthening, derotation) were performed.
• Indications included congenital/acquired distal tibial deformities and asymmetric ankle arthritis with partially preserved cartilage.
• Postoperative management involved 6 weeks of partial weight-bearing followed by progressive weight-bearing based on osseous healing.

Main Results:

• Fifteen patients (average age 41.8 years) underwent the procedure with an average follow-up of 28.7 months.
• Mean American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score improved from 54.3 preoperatively to 74.2 postoperatively.
• Complications requiring surgical intervention occurred in 26.7% of patients, and hardware removal was performed in 60%.

Conclusions:

• Supramalleolar osteotomy is a viable option for correcting distal tibial malalignment and preserving the ankle joint in select patients.
• The procedure can lead to significant improvements in functional scores, but careful patient selection is necessary due to potential complications.