Malalignment of the distal tibia and ankle is a common problem that is largely left untreated even in this era of modern orthopedics. Supramalleolar osteotomies for ankle osteoarthritis request pdf. Singlestage supramalleolar osteotomy for coronal plane. Supramalleolar osteotomies for degenerative joint disease. Supramalleolar osteotomies for ankle osteoarthritis. T1 changes in ankle joint motion after supramalleolar osteotomy. The shortterm and midterm results after realignment surgery, published in the current literature, are very promising with substantial pain relief and functional improvement observed postoperatively. Jun 01, 2006 the articles prior to january 20 are part of the back file collection and are not available with a current paid subscription.
The purpose of this present study was to determine the incidence of lateral cortical fracture depending on the plane of osteotomy in medial openwedge supramalleolar osteotomy smo and to define. A range of outcome variables was collected, prospectively, for 57 patients 91 osteotomies, including thigh foot angle, foot progression angle, postoperative complications and serial radiographs. The main indication for supramalleolar osteotomies is asymmetric ankle oa with concomitant valgus or varus deformities and a partially at least 50 % preserved tibiotalar joint surface 25, 26. The role of fibular for supramalleolar osteotomy in treatment. Tanakay,takakuray,hayashik,taniguchia,kumait,sugimoto. Supramalleolar osteotomies for degenerative joint disease of the. Safe zone for medial openwedge supramalleolar osteotomy. A total of 16 patients with asymmetric ankle osteoarthritis and concomitant supramalleolar deformity 7. The purpose of this present study was to determine the incidence of lateral cortical fracture depending on the plane of osteotomy in medial openwedge supramalleolar osteotomy smo and to define a safe zone through which a medial openwedge smo could be performed with minimal risk of lateral cortical fracture.
Additional mesenchymal stem cell injection improves the outcomes of marrow stimulation combined with supramalleolar osteotomy in varus ankle osteoarthritis. In patients with asymmetric ankle arthritis, ankle realignment surgery with a supramalleolar osteotomy smo has shown promising, though variable, clinical results. Effect of a supramalleolar osteotomy in a novel asymmetric. Aug 20, 20 patients with varus or valgus hindfoot deformities usually present with asymmetric ankle osteoarthritis.
Supramalleolar osteotomy using circular external fixation. Malalignment of the ankle joint has been found after trauma, by neurological disorders, genetic. The main goal of this retrospective study was to evaluate the clinical and radiological benefits of supramalleolar osteotomy. Indications for supramalleolar osteotomy in patients with. Smos may have a left or right foot sticker on the bottom of the device. Supramalleolar osteotomy for treatment of posttraumatic angular.
The aim of this prospective study was to analyze shortterm clinical and radiographic outcomes in patients with asymmetric ankle osteoarthritis. The indications and technique of supramalleolar osteotomy. The results are satisfactory for indications of arthritis with varus and valgus deformities and a positive sidewalk sign pain relief on a slope surface tilted in the opposite direction of the deformity. Oct 18, 2017 supramalleolar osteotomy is a jointpreserving option that can be considered in patients who have asymmetric ankle osteoarthritis, a partially preserved ankle joint, and a concomitant. A cohort study of patients undergoing distal tibial. Supramalleolar derotation osteotomy of the tibia, with t. A positive sidewalk sign disappearance of pain was correlated with a good outcome and had a positive predictive value of 0. For a medial open wedge supramalleolar osteotomy smo, there are some debates as to whether concurrent fibular osteotomy should be performed.
Eight cadaveric lower legs with 10 varusvalgus smot models were tested. Changes in ankle joint motion after supramalleolar. Preoperative standing anteroposterior and saltzman view radiographs were taken to. This is supramalleolar osteotomy juxtaarticular deformity 30 sec demo by ian ryan interactive on vimeo, the home for high quality videos and the people. Prevent ankle arthritis treat ankle arthritis improve alignment for a fusion or replacement may need to combine with. A supramalleolar osteotomy is considered in cases where the origin of deformity is located above the ankle joint fig. Ankle arthrodesis is indicated for painful arthroses, instability, malalignment, and joint sepsis. A variety of surgical procedures are utilized for management of ankle osteoarthritis. Although the supramalleolar osteotomy can shift the weightbearing axis laterally, it cannot reconstruct a widened ankle mortise caused by progression of medial ankle osteoarthritis. Supramalleolar osteotomy for the treatment of distal tibial angular deformities and arthritis of the ankle joint. We conducted a prospective study in two centres, to investigate the outcome of supramalleolar derotation osteotomy of the tibia, using internal fixation with the aoasif t plate. Techniques, indications and outcomes in a series of 83 cases orthop. Research article open access changes in ankle joint motion after supramalleolar osteotomy.
Our hypothesis was that the pin fixation group would have comparable outcomes without the need for a secondary procedure for implant removal. A supramalleolar osteotomy helped to normalize this cop shift, more so when combined with fibular osteotomy. The aim of this study was to evaluate radiographic and clinical outcomes of distal tibial osteotomy without. The primary goal of the procedure is to realign the spatial relationship between the talus and tibia and thereby normalize joint loading within the ankle. It is the most common pediatric foot problem and is. Aug 20, 20 the osteotomy is widened until a physiological position of the hindfoot correction of valgus and midfoot correction of abductus and restoration of the medial arch is achieved.
Supramalleolare osteotomie bei asymmetrischer arthrose des. Supramalleolar osteotomy is a jointpreserving option that can be considered in patients who have asymmetric ankle osteoarthritis, a partially preserved ankle joint, and a concomitant. Pdf supramalleolar osteotomies for the treatment of ankle. Supramalleolar definition of supramalleolar by medical. However, few studies have examined the role of fibular osteotomy in smot. Indications for the supramalleolar osteotomy are numerous and include correction of deformity, joint preservation, and as a staged procedure that leads up to other operations, including total ankle replacement. Supramalleolar osteotomy is being described here as a salvage procedure for the treatment of the uncommon complex rigid multiplanar hindfoot deformities with previous postoperative scarring or scarring from severe burns. Another important indication for realignment osteotomies are isolated osteochondral lesion of the medial or lateral aspect of the tibiotalar joint.
The supramalleolar osteotomy is a commonly used surgical procedure to correct congenital or acquired deformities of the distal tibia, ankle, or. Supramalleolar tibial osteotomy secured with the puddu plate. A substantial part of tibiotalar joint is often preserved, therefore, in appropriate patients, jointpreserving surgery holds the. Patients with varus or valgus hindfoot deformities usually present with asymmetric ankle osteoarthritis. Ldta 1150 pronation compensation edta 50 supination compensation be aware of foot compensation and determine if it is flexible or fixed. The role of fibular for supramalleolar osteotomy in. Low tibial osteotomy for osteoarthritis of the ankle. Delayed surgical reconstruction of adult ankle malunion by supramalleolar osteotomy background. Supramalleolar osteotomy is an effective surgical procedure for the treatment of ankle impingement in patients with an overcorrected congenital clubfoot deformity. Oct 24, 2016 supramalleolar osteotomy smot is a wellaccepted treatment method for midstage varus ankle osteoarthritis oa. Additional mesenchymal stem cell injection improves the. Supramalleolar osteotomy for posttraumatic malunion, developmental or physeal deformities, congenital malalignment, or focal articular degenerative problems in the ankle is a useful surgical technique. The procedure aims to translate the ankle joint to be in line with the weight.
May 27, 2017 supramalleolar osteotomy with external fixation perspective 2 ankle arthrodesis remains the gold standard for ankle arthritis. Multiplanar supramalleolar osteotomy in the management of. Schuberth realignment osteotomy of the distal tibia is a valuable surgical procedure for the treatment of distal tibial malalignment resulting from posttraumatic malunion, physeal disturbances, congenital and metabolic diseases, and degenerative arthritis 1,2,3,4,5,6,7,8,9,10 and 11. Direct url citations appear in the printed text and are provided in the html and pdf versions of this article on the journals. Pdf supramalleolar derotation osteotomy of the tibia. Osteotomy was the primary surgical procedure in all patients after failure of nonoperative measures. Several studies have discussed the use of supramalleolar osteotomy to correct distal tibial and foot and ankle deformities in the pediatric population for. Supramalleolar osteotomies for the treatment of ankle. We assessed the changes in motion of ankle joint and plantar pressure after supramalleolar osteotomy without fibular osteotomy. Kent ellington, md, charlotte, nc describes the key steps for using the arthrex calcaneus step plate for stable and solid fixation of medial calcaneal displacement osteotomy. Ankle malunion is a common cause of chronic pain, posttraumatic arthritis and work related disability.
Supramalleolar osteotomy with medial distraction arthroplasty for. Data were evaluated on patients undergoing a rotational supramalleolar osteotomy over a 10year span with followup to union. The supramalleolar osteotomy is a conservative therapeutic surgical option for the management of arthritis of the ankle associated with varus or valgus deformities. The supramalleolar osteotomy is a commonly used surgical procedure to correct congenital or acquired deformities of the distal tibia, ankle, or foot. Many authors have looked at the use of ilizarov external fixators for the correction of complex foot deformities. The articles prior to january 20 are part of the back file collection and are not available with a current paid subscription. Delayed surgical reconstruction of adult ankle malunion by supramalleolar osteotomy. Pdf supramalleolar osteotomies for the treatment of. Pdf supramalleolar osteotomies for the treatment of ankle arthritis. Arthrex medializing calcaneal osteotomy using the step. The osteotomy gap can be filled with allograft or autograft 51, 52. Include any exams preformed under anesthesia positioning describe and provide or photos to illustrate p.
Supramalleolar osteotomy for moderate degenerative ankle. The most common etiology in patients with ankle osteoarthritis is posttraumatic often resulting in asymmetric ankle osteoarthritis with concomitant valgus or varus deformity. A closer look at the distal tibial osteotomy for ankle varus. When varus osteotomy was combined with fibular osteotomy, mean cop. The surgical technique of smot for fibular osteotomy has been well described in a previous study. Invitro biomechanical studies have shown that varus or valgus hindfoot deformity may lead to altered load distribution in the tibiotalar joint which may result in medial varus or lateral valgus tibiotalar joint degeneration in the short or medium term. Delayed surgical reconstruction of adult ankle malunion by. The use of supramalleolar osteotomies in posttraumatic.
Malunion of the ankle fractures is a frequent cause of morbidity. Long term effects of distal tibia deformity correction. Percutaneous supramalleolar osteotomy using the ilizarov. Supramalleolar osteotomy for posttraumatic malunion, developmental or physeal deformities, congenital malalignment, or focal articular degenerative problems in the ankle is a useful surgical. Other osseous realignment below the ankle soft tissue balancing make the osteotomy as close to the cora as possible varus opening wedge or dome. The lack of interest in treating these deformities can be attributed to the deficiency of a safe and reliable method for correction. Osteotomy of the tibia and fibula plastic surgery key. A cohort study of patients undergoing distal tibial osteotomy. Read indications for supramalleolar osteotomy in patients with ankle osteoarthritis and varus deformity, journal of bone and joint surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips.
Supramalleolar osteotomy is an alternative surgical procedure for the management of asymmetric early arthritis of the ankle. Safe zone for medial openwedge supramalleolar osteotomy of. Supramalleolar osteotomy is a jointpreserving surgical treatment for patients with asymmetric valgus or varus ankle arthritis. Changes in ankle joint motion after supramalleolar osteotomy. Learn more about how to use your supramalleolar orthosis smo. Supramalleolar osteotomies for degenerative joint disease of. For a medial open wedge supramalleolar osteotomysmo, there are some debates as to whether concurrent fibular osteotomy should be performed. As a principle, it is done before replacement of the ankle. Supramalleolar osteotomy smot is a wellaccepted treatment method for midstage varus ankle osteoarthritis oa. Pdf supramalleolar osteotomy is a jointpreserving surgical treatment for patients with asymmetric valgus or varus ankle arthritis. Supramalleolar osteotomy is a viable option for mildmoderate arthritis with deformity patient selection plays an important role preserves motion and corrects malalignment future replacement or fusion are not compromised in event of failure. Supramalleolar lateral closing wedge osteotomy for the treatment of varus. Supramalleolar osteotomy with external fixation perspective 2.
Conclusion supramalleolar osteotomy is an effective procedure for treating symptomatic angular deformities of the tibia. The main indication for the supramalleolar osteotomy is asymmetric ankle osteoarthritis with concomitant supramalleolar valgus or varus deformity. Indications discuss indications and more general concerns. The objective of the current study was to compare the biomechanical and clinical outcomes of smot with and without fibular osteotomy. Osteotomy is performed for correction of a malunion of a distal tibia. A supramalleolar osteotomy is the preferred option. Supramalleolar osteotomy with external fixation perspective 2 ankle arthrodesis remains the gold standard for ankle arthritis. A isolated varus supramalleolar osteotomy using 5,10, and 15degree wedges caused the cop to shift in a posteromedial direction, with a mean shift of 3. Normal variants of the lower limbs in pediatric orthopedics. Supramalleolar osteotomy juxtaarticular deformity 30 sec. The sticker indicates the correct foot the device goes on, even if they appear to be wrong. Supramalleolar osteotomies for degenerative joint disease of the ankle joint. This condition refers to medial deviation of the forefoot relative to a normal hindfoot.
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