Osteotomien - Distaler Unterschenkel und Sprunggelenk

Zwipp, H.; Grass, R.; Rammelt, Stefan

doi:10.1055/s-0031-1280429

Cited by 4 publications

(1 citation statement)

References 6 publications

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“…Even slightly dis-located bony avulsions of the anterior or posterior syndesmosis can provoke postoperative malposition of the distal fibula in the tibial incisura. In our experience, they are one of the most frequent causes for unsatisfactory reduction of the ankle mortise after malleolar fractures [47].…”

Section: Overlooked Anterior Syndesmosis Avulsionsmentioning

confidence: 83%

Early Corrections after Failed Ankle Fracture Fixation

2020

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Even minor residual fragment malpositioning after internal fixation of ankle fractures is associated with a worse prognosis. Frequent causes for non-anatomical reduction are fibular shortening due to comminuted fractures or poor bone quality, translational or rotational malpositioning of the distal fibula within the tibial incisura with unstable syndesmosis injuries, and inadequately addressed bony avulsions of the tibiofibular syndesmosis. After operative treatment of fracture dislocations with syndesmotic fixation, in case of complex fracture pathoanatomy, and with suspected non-anatomic reduction in postoperative radiographs, computed tomography imaging of both ankles should be performed. Correction of relevant malreductions should be performed as early as possible in order to speed up rehabilitation and to avoid late sequelae due to a load shift or instability in a weight-bearing joint.

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Section: Overlooked Anterior Syndesmosis Avulsionsmentioning

confidence: 83%

Early Corrections after Failed Ankle Fracture Fixation

2020

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Sprunggelenkfrakturen und Korrektur von Fehlheilungen

Ochman

Rammelt

2018

Rückfußchirurgie

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Joint-preserving osteotomy of malunited ankle and pilon fractures

2013

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Malunion and nonunion after ankle and pilon fractures regularly lead to the development of painful functional impairment even in cases of only mild axial deviation or residual joint incongruity. Involvement of the tibial pilon results in rapid progression of posttraumatic ankle arthritis. Corrective osteotomy with joint preservation aims at secondary anatomical reconstruction with functional rehabilitation. This requires a careful preoperative analysis and will be possible in carefully selected cases only. Prerequisites for successful reconstruction are intact cartilage, sufficient bone quality, residual joint function and good patient compliance. Since the works of B. G. Weber, joint-sparing osteotomy is an established treatment option for malunited malleolar fractures with reliable long-term results and low rates of complications and secondary fusions. Key to success is the re-establishment of the length of the distal fibula and repositioning into the tibial incisura in cases of syndesmotic instability. Corrections of the medial malleolus and posterior tibial fragment are less frequent. Corrective intra-articular osteotomies for malunited pilon fractures are rarely feasible because of manifest arthritis at the time of patient presentation in most cases. Besides case reports there is only one series of 14 patients available in the literature. At 5-year follow-up, a good to excellent result was seen in 10 cases and secondary ankle fusion was done in 2 patients with a poor result. Anatomical reconstruction of malunited tibial pilon fractures appears to be a viable treatment option besides arthroplasty and fusion in carefully selected patients.

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Osteotomien - Distaler Unterschenkel und Sprunggelenk

Cited by 4 publications

References 6 publications

Early Corrections after Failed Ankle Fracture Fixation

Early Corrections after Failed Ankle Fracture Fixation

Sprunggelenkfrakturen und Korrektur von Fehlheilungen

Joint-preserving osteotomy of malunited ankle and pilon fractures

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