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Page 1: Realignment Osteotomy in Fibular Malunion

A. Barg, M. Wiewiorski, H.B. Henninger, V. Valderrabano

RealignmentOsteotomyinFibularMalunion

Department of Orthopaedics

AOFAS Annual Meeting, Toronto, Ontario, 20th‐23rd July 2016

Page 2: Realignment Osteotomy in Fibular Malunion

No conflict to disclose

Disclosure

Page 3: Realignment Osteotomy in Fibular Malunion

Exact incidence of distal fibula malunions after fibula Fxis now know  up to 33%1

The most frequent malunions of the fibula are shortening and malrotation:

– widening of the ankle mortise and talar instability1,2

Fibula malunion as a risk factor for development of ankle osteoarthritis:

– biomechanical cadaver study3– clinical long‐term studies4,5

DistalFibulaMalunionsIntroduction Patients and Methods Results Discussion

Page 4: Realignment Osteotomy in Fibular Malunion

Patients with symptomatic posttraumatic fibula malunion:

– our treatment algorithm and surgical technique– intra‐ and postoperative complications– mid‐term radiographic outcomes– mid‐term clinical outcomes including quality of life

OurStudyIntroduction Patients and Methods Results Discussion

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19 consecutive patients (19 ankles):– posttraumatic non‐union or mal‐union of fibula– 11 ♂, 8♀, mean age 42 ± 9 years (range, 19 – 67 years)

Initial injury:– type Weber B Fx (n = 7), type Weber C Fx (n = 12)– mean time latency 14 months (range, 6 – 101 months)

PatientsIntroduction Patients and Methods Results Discussion

Page 6: Realignment Osteotomy in Fibular Malunion

Z‐shaped corrective fibular osteotomy

SurgicalTechniqueIntroduction Patients and Methods Results Discussion

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Z‐shaped corrective fibular osteotomy Pathological medial distal tibial angle:

– supramalleolar corrective tibia osteotomy6 (n = 4)

Inframalleolar malalignment:– corrective calcaneal osteotomy7 (n = 8)

SurgicalTechnique

[1] Barg & Saltzman, Curr Rev Musculoskelet Med, 2014; [2] Tennant et al, Curr Rev Musculoskelet Med, 2014.

Introduction Patients and Methods Results Discussion

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Assessment of the distal fibula length:– Weber Criteria1

RadiographicAssessmentIntroduction Patients and Methods Results Discussion

equal joint space Shenton’s line Weber’s circle

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There were no intraoperative complications Perioperative complications:

– 2 patients with early wound healing problems– both resolved with i.v. antibiotics

Osseous healing:– in all ankle within 10 weeks after surgery

Length and rotation of the fibula:– improved in all ankles– according to 3 Weber criteria

ResultsIntroduction Patients and Methods Results Discussion

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Mean follow‐up 4.9 years:– range, 3.2 – 6.7 years– no patients were lost for follow‐up

Significant functional improvement:– AOFAS:  48.4 ± 14.5  85.7 ± 7.4  (p < 0.001)– ROM:  37° ± 6° 46° ± 5° (p < 0.001)

Substantially improved quality of life:– 8 SF‐36 score subgroups

Hardware removal:– in 11 patients– mean time 11.8 months (range, 7.2 – 22.8 months)

ResultsIntroduction Patients and Methods Results Discussion

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Conclusions Fibula mal‐union:

– is not rare!– exact incidence is not known

Negative effects on ankle biomechanics Important long‐term predictor for ankle osteoarthritis development

Reconstructive fibula osteotomy:– exact planning important for appropriate correction– well‐promising mid‐term results– may avoid or at least postpone ankle osteoarthritis– long‐term studies are needed

Introduction Patients and Methods Results Discussion

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1. Chu & Werner, J Am Acad Orthop Surg, 20092. van Wensen et al., Strat Traum Limb Recon, 20113. Thordarson et al., J Bone Joint Surg Am, 19974. Horisberger et al., J Orthop Trauma, 20095. Lübbeke et al., Int Orthop, 20126. Barg & Saltzman, Curr Rev Musculoskelet Med, 20147. Tennant et al., Curr Rev Musculoskelet Med, 20148. Weber & Simpson, Clin Orthop Relat Res, 1985

References


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