Late revision of fibular malunion in ankle fractures

Eleven patients with fibular malunion after ankle fracture healed with stiff, painful joints and radiographic evidence of fibular malunion, diastasis of the ankle mortice, and talar tilt. Reconstruction was performed by mobilizing the fibula (by osteotomy or through the old fracture site), lengthening the fibula, and restoring the ankle mortice anatomically. The operation was done three months to three years after the initial fracture in patients ranging in age from 26 to 52 years. The average follow-up period was 3.3 years. Radiographically, seven patients had the ankle joint restored anatomically. Four patients had residual talar tilt. On clinical assessment, eight patients were rated as good, two fair and improving, and one poor resulting in fusion. Good functional results were maintained at long-term follow-up examination. The factors that determined the success of the revision were the duration of the malunion, the quality of the reduction achieved, and the condition of the articular cartilage at the time of revision. Late correction of the malunited fibula with diastasis of the ankle mortice is an effective means of salvaging function in a joint otherwise destined to be stiff and painful.