Supramalleolar osteotomy combined with an intraarticular. The objective of the current study was to compare the biomechanical and clinical outcomes of smot with and without fibular osteotomy. We assessed the changes in motion of ankle joint and plantar pressure after supramalleolar osteotomy without fibular osteotomy. Regardless of the method of arthrodesis, complications are not uncommon and include nonunion, malunion, infection, osteoarthrosis of contiguous joints, neurovascular injury, wound healing issues, and limblength discrepancy. The major steps of the procedure, which are demonstrated in this. Mid to longterm results of supramalleolar osteotomy. Supramalleolar osteotomy combined with lateral ligament. Ten lower leg specimens below the knee were prepared from freshfrozen human cadavers. This recent study addressed the effect of supramalleolar osteotomies and total ankle replacement on talar position in all three planes. Since then realignment procedure has been constantly gaining more.
Safe zone for medial openwedge supramalleolar osteotomy. This is supramalleolar osteotomy juxtaarticular deformity 30 sec demo by ian ryan interactive on vimeo, the home for high quality videos and the people. Effect of supramalleolar osteotomy and total ankle replacement on talar position in the varus osteoarthritic ankle. High tibial osteotomy postoperative rehabilitation protocol. A jointpreserving procedure table 1 should be considered in younger and active patients. The purposes of this study were to investigate pain experienced by patients after supramalleolar osteotomy for varus ankle osteoarthritis and to analyse correlations between this pain and arthroscopic findings. Historical perspective on supramalleolar osteotomy. Supra malleolar osteotomies for neglected tibial deformity. The role of fibular for supramalleolar osteotomy in treatment. Effect of a supramalleolar osteotomy in a novel asymmetric.
Malunion of a medial impacted ankle fracture may cause varus ankle deformity. Supramalleolar osteotomy has been frequently reported as a surgical option in the pediatric population. Similarly, both open and close wedge supramalleolar osteotomies smo have been done for the treatment of malalignment. A foundation of understanding normal alignment is presented, using new nomenclature that is easy to remember and can even be derived without memorization. Techniques, indications and outcomes in a series of 83 cases orthop. Principles of deformity correction is a comprehensive text on the analysis, planning, and treatment of lower limb deformities in an accessible and instructive format. 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. Arthrex medializing calcaneal osteotomy using the step. While most publications focus on the etiology of bsaj 14,610,17,2124, very little data exists for the management of this deformity. Preoperatively, all patients experienced progressive difficulty with brace use, and anteroposterior weightbearing ankle radiographs showed a valgus tilt of the talotibial angle tta of. Based on improved mobility scores, supramalleolar osteotomy is a useful means of improving ambulation, even with severe deformity. Conclusion supramalleolar osteotomy is an effective procedure for treating symptomatic angular deformities of the tibia.
We assessed the changes in motion of ankle joint and plantar. A positive sidewalk sign disappearance of pain was correlated with a good outcome and had a positive predictive value of 0. Supramalleolar wedge osteotomy is an effective method for correcting recurrent equinus with associated rotational and angular deformities. Supramalleolar tibial osteotomy combined with fibular osteotomy was performed in sixteen ankles sixteen patients to treat moderate medial ankle osteoarthritis. Smos may have a left or right foot sticker on the bottom of the device. Recognize vascular, nerve or other associated injuries. 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. Malalignment of the ankle joint has been found after trauma, by neurological disorders, genetic predisposition and other unidentified factors, and results in asymmetrical joint loading.
Supramalleolar osteotomy with external fixation perspective 2. 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. 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. Supramalleolar osteotomy is an effective surgical procedure for the treatment of ankle impingement in patients with an overcorrected congenital clubfoot deformity. It teaches the analysis, planning, and methods of deformity correction. Pdf supramalleolar osteotomy is a jointpreserving surgical. Ankle distraction arthroplasty and supramalleolar osteotomy have been independently shown to improve pain and function for patients with ankle arthritis. Ankle distraction and supramalleolar osteotomy for. Learn more about how to use your supramalleolar orthosis smo.
Supramalleolar osteotomies for the treatment of asymmetric ankle arthritis have been shown in multiple studies to improve the functionality of patients while improving the radiologic evidence of arthritis. 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. It is a tried and true procedure that provides the surgeon and patient. Cancelliere p 2016 supra malleolar osteotomies for neglected tibial. Supramalleolar definition of supramalleolar by medical. Appropriately interprets basic imaging studies and recognizes fracture patterns. Singlestage supramalleolar osteotomy for coronal plane deformity. Asymmetric and neutral osteoarthritis can reportedly be treated with realignment surgery. Supramalleolar osteotomy for the treatment of distal tibial angular deformities and arthritis of the ankle joint emmanouil d.
Singlestage supramalleolar osteotomy for coronal plane. Jul 06, 2011 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. This technique maintains mobility and restores a plantigrade functional foot. The patient started with pain at the ankle approximately 10 years after the accident. The use of supramalleolar osteotomies in posttraumatic. The main goal of this retrospective study was to evaluate the clinical and radiological benefits of supramalleolar osteotomy. 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. Supramalleolar osteotomy, ankle realignment surgery. 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. Ankle arthrodesis remains the gold standard for ankle arthritis. Figure 3 from supramalleolar derotation osteotomy of the. Supramalleolar osteotomies for ankle osteoarthritis.
Supramalleolar derotation osteotomy of the tibia, with t. Supramalleolar osteotomies for degenerative joint disease of the. Patients with varus or valgus hindfoot deformities usually present with asymmetric ankle osteoarthritis. It was performed with internal and external fixation achieving an aligned extremity and a good clinical outcome. At the latest followup, 41 patients were pain free. The sticker indicates the correct foot the device goes on, even if they appear to be wrong. 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. Supramalleolar deformities are a common cause of ankle osteoarthritis, with 80%. The annals of the royal college of surgeons of england, 1015, pp.
The location and progress of the osteotomy were controlled by fluoroscopy figure 2. Supramalleolar osteotomy juxtaarticular deformity 30 sec. Pdf supramalleolar derotation osteotomy of the tibia, with. Oct 24, 2016 supramalleolar osteotomy smot is a wellaccepted treatment method for midstage varus ankle osteoarthritis oa. Supramalleolar osteotomies for degenerative joint disease of. 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. Malalignment of the ankle joint has been found after trauma, by neurological disorders, genetic. The use of supramalleolar osteotomies in posttraumatic defor. A novel technique for supramalleolar osteotomy of the. 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. A closer look at the distal tibial osteotomy for ankle varus. Most patients 47 patients were painfree and six patients reported.
Treatment of varus ankle osteoarthritis and instability with a novel. May 27, 2017 supramalleolar osteotomy with external fixation perspective 2 ankle arthrodesis remains the gold standard for ankle arthritis. Other osseous realignment below the ankle soft tissue balancing make the osteotomy as close to the cora as possible varus opening wedge or dome. Pdf supramalleolar derotation osteotomy of the tibia. For a medial open wedge supramalleolar osteotomy smo, there are some debates as to whether concurrent fibular osteotomy should be performed. The use of supramalleolar osteotomies in posttraumatic deformity. Ankle arthrodesis is indicated for painful arthroses, instability, malalignment, and joint sepsis. Correction of thigh foot angle and foot progression. Safe zone for medial openwedge supramalleolar osteotomy of. Supramalleolar osteotomy for the treatment of distal tibial angular deformities and arthritis of the ankle joint. Different surgical techniques of supramalleolar osteotomy that are based. When varus osteotomy was combined with fibular osteotomy, mean cop. Supramalleolar tibial osteotomy secured with the puddu plate.
Indications for supramalleolar osteotomy in patients with. Prevent ankle arthritis treat ankle arthritis improve alignment for a fusion or replacement may need to combine with. Ankle distraction is utilized to fill areas of eburnated bone with a layer of cartilagelike matrix and. At 3 month follow up, the patient was walking pain free with no insert required and no. However, few studies have examined the role of fibular osteotomy in smot. Supramalleolar osteotomies for ankle osteoarthritis request pdf. A novel technique for supramalleolar osteotomy of the tibia. Technique and results in patients with neuromuscular disease. Eight cadaveric lower legs with 10 varusvalgus smot models were tested. Supramalleolar osteotomy using circular external fixation.
Supramalleolar osteotomy for tibiotalar varus malalignment. Supramalleolar osteotomy for the treatment of distal tibial. During this time, manual lymphatic drainage and continuous passive movement of ankle was also initiated. Supramalleolar derotation osteotomy of the tibia, with t plate fixation. Dec 26, 2014 a supramalleolar osteotomy smo was offered to the patient to correct the deformity.
Research article femoral derotation osteotomy in adults. Supramalleolar osteotomy for posttraumatic malunion, developmental or physeal deformities, congenital malalignment, or focal articular degenerative problems in the ankle is a useful surgical. Jul 30, 2014 the purposes of this study were to investigate pain experienced by patients after supramalleolar osteotomy for varus ankle osteoarthritis and to analyse correlations between this pain and arthroscopic findings. Supramalleolar osteotomies for degenerative joint disease. The main indication for supramalleolar osteotomies is asymmetric ankle oa with. Foot and ankle corrective supramalleolar osteotomy for. Supramalleolar dome osteotomy for malunion of the tibia. A supramalleolar osteotomy smo was offered to the patient to correct the deformity. Varus or valgus malalignment is commonly seen in patients with asymmetric ankle arthritis. The journal of orthopaedic research, a publication of the orthopaedic research society ors, is the forum for the rapid publication of high quality reports of new information on the full spectrum of orthopaedic research, including life sciences, engineering, translational, and clinical studies. This biomechanical study was performed to know the changes in motion of ankle joint and plantar pressure after supramalleolar osteotomy without fibular osteotomy.
When combined, these techniques may be synergistic, providing further improved results. The average postoperative correction of tta was 17. Arthroscopic evaluation of persistent pain following. We have confirmed that our novel procedure overcomes some limitations of traditional supramalleolar osteotomy and plafondplasty. T1 changes in ankle joint motion after supramalleolar osteotomy. Changes in ankle joint motion after supramalleolar osteotomy. Supramalleolar osteotomy for treatment of posttraumatic angular. Supramalleolar osteotomy is an alternative surgical procedure for the management of asymmetric early arthritis of the ankle. Aug 20, 20 patients with varus or valgus hindfoot deformities usually present with asymmetric ankle osteoarthritis. Ankle distraction and supramalleolar osteotomy for arthrosis. Pdf supramalleolar osteotomies for the treatment of ankle arthritis. The followup xrays showed a distal tibia valgus deformity that was interpreted as a posttraumatic tibial malunion.