Ankle Malunion: A Systematic Case-Based Approach to Treatment and a Modified Classification.

Area of Science:

• Orthopedic Surgery
• Anatomy
• Biomechanics

Background:

• Ankle malunion is a frequent complication of inadequate treatment, leading to pain, gait issues, and arthritis.
• Current classification systems lack the detail needed for effective treatment planning.
• Advanced imaging has improved understanding of ankle anatomy and mechanics.

Purpose of the Study:

• To review the evolution of understanding ankle malunion.
• To introduce a new, comprehensive classification system for ankle malunion.
• To present a systematic management plan based on the new classification.

Main Methods:

• Literature review on ankle malunion evolution (biomechanics, imaging, classifications).
• Development and application of the Patel-Dhillon Classification.
• Analysis of six clinical cases to demonstrate the classification and treatment algorithm.

Main Results:

• The Patel-Dhillon Classification categorizes malunions into Type I (Extra-articular), Type II (Intra-articular), and Type III (Complex).
• Four modifiers (Arthritis, Previous Surgery, Soft Tissue Status, Syndesmotic Status) enhance classification detail.
• A treatment algorithm based on the classification was presented and validated with case studies.

Conclusions:

• A detailed, patho-anatomy driven classification is crucial for accurate diagnosis and personalized surgical planning.
• The proposed Patel-Dhillon Classification addresses the limitations of existing systems.
• This classification aids in standardizing research and predicting outcomes for ankle malunion.