Fibular-Lengthening Osteotomy in Patient with Progressive Valgus Deformity After an Ankle Fracture

Fibular Malunion: Diagnosis, Treatment, and Prevention

Malunions of the fibula are caused by malreduction during initial surgical management or the result of nonoperative treatment of an unstable ankle fracture. They can cause significant changes in loading of the ankle and subsequently lead to arthritic changes. Timely recognition of abnormal anatomy and corrective osteotomy yields favorable results. The current review addresses the anatomy and biomechanics of the ankle and the effects of a malunited fibula fracture. The radiological workup is discussed as well as the technique of the osteotomy. Last, the authors highlight the expected outcome and possible complications for an optimal informed consent of the patient.

A systematic review: Radiological findings at a minimum of 3 years follow-up for unstable ankle fractures in adults treated with surgery

BACKGROUND

Radiological investigations are critical to diagnosis and treatment of many musculoskeletal diseases including detecting earliest degenerative changes (osteoarthritis (OA)) seen in patients with unstable ankle fractures managed surgically. Despite the high incidence of ankle OA, research into early detection using imaging remains sparse.

OBJECTIVES

To identify the incidence of OA on postoperative imaging in adults with unstable ankle fractures after a minimum follow-up of 3 years with a correlation to patient reported outcomes.

KEY FINDINGS

767 studies were identified on 5 database searches, and 492 abstract titles were screened, while 53 papers were selected for full review. From these only 8 articles met the inclusion criteria. A total of 905 participants aged 18 years and above (mean 46.4 years, 53.8 % male) presented with a range of ankle fracture classifications. This includes 423 cases of Weber classification, 225 cases of OTA/AO, 204 Lauge-Hansen classification, and 53 medial malleoli. From these, 34.7 % cases of OA were identified (minimum of the 3-year follow-up) on different imaging modalities. Our results revealed that mild to moderate OA is common, and functional outcome is mainly good to excellent.

CONCLUSION

1 in 3 patients treated for unstable ankle fracture with open reduction internal fixation will show signs of radiological OA after 3-7 years of index procedure, though with good functional outcome. We were unable to correlate the grade of radiological OA observed with clinical OA. Despite the low sensitivity of X-ray in early detection of OA, we identified a lack of studies in utilising MRI and/or CT imaging, indicating the need for further research. Clinicians should consider using MRI/CT imaging for early detection of OA for patients following unstable ankle fractures, to improve early detection and consequently improve patient reported outcomes.

LEVEL OF CLINICAL EVIDENCE

Systematic review = 1.