Distal Tibial Osteotomy without Fibular Osteotomy for Medial Ankle Arthritis with Mortise Widening.

ABSTRACT

INTRODUCTION: A patient with medial ankle osteoarthritis and a widened ankle mortise can be treated successfully with an oblique distal tibial osteotomy, without fibular osteotomy, to narrow the mortise and shift the weight-bearing axis to a more normal position. STEP 1 PATIENT POSITIONING AND PREOPERATIVE ASSESSMENT With the patient under spinal or general anesthesia, check for mortise widening with a valgus stress test. STEP 2 SURGICAL APPROACH: Expose the ankle joint through an anterior approach. STEP 3 CORRECTIVE OSTEOTOMY Perform an oblique osteotomy of the distal part of the tibia and narrow the widened mortise by shifting the osteotomized fragment. STEP 4 FIXATION AND BONE-GRAFTING Stabilize the osteotomy site with a locking plate and apply bone graft to the osteotomy site. STEP 5 CLOSURE Close the soft tissue in layers. RESULTS: Eighteen patients (fifteen female and three male; mean age, fifty-seven years) with symptomatic medial ankle osteoarthritis and mortise widening underwent distal tibial oblique osteotomy without fibular osteotomy between 2008 and 2011.IndicationsContraindicationsPitfalls & Challenges.