Abstract
|
Introduction:Incidence of fibula fractures continues to increase. The exact incidence of distal fibula malunions after fibular reconstructions is unknown, but up to 33% is described in literature. Most frequent malunions of the fibula are shortening and malrotation, resulting in widening of the ankle mortise, talar instability and it has been demonstrated that substantial fibular displacement may increase contact pressures. Therefore distal fibular malunion is a risk factor for development of posttraumatic ankle osteoarthritis. Objectives of this study were to describe our treatment algorythm and surgical technique in patients with posttraumatic fibula malunions; determine intra- and postoperative complication rates, describe mid-term clinical and radiological outcomes and quality of life.Methods:21 consecutive patients (12♂, 9♀, mean age 42 y) with symptomatic fibular malunions were included in this prospective study. The initial injury was Weber B and C fracture in 7 and 14 ankles. Mean time between the injury and reconstructive surgery was 17.5 months. In all patients a z-shaped osteotomy of the fibula was performed to achieve the appropriate length/rotation of the fibula. Fixation was performed using a plate. If necessary, supramalleolar and inframalleolar deformities were corrected by supramalleolar tibial and calcaneal osteotomies. All patients were evaluated pre- and postoperatively (mean follow-up 5.6y). Radiological outcomes were assessed using standardized weight-bearing radiographs and clinical outcomes using VAS, AOFAS and SF-36 score.Results:No intraoperative complications. In two patients early wound healing problems occurred and resolved with i.v. antibiotics. Healing was observed in all ankles within 10 weeks after surgery. Length and rotation of the fibula was improved in all patients, according to Weber criteria. All patients experienced significant pain relief (VAS: 6.5 ± 1.1 to 1.1 ± 0.9, P < 0.001) and functional improvement (AOFAS: 47.1 ± 14.5 to 85.0 ± 7.5, P < 0.001; ROM:37° ± 6° to 45° ± 5°, P < 0.001). The SF-36 score increased significantly in all subgroups. In 11 patients hardware was removed due to a discomfort after a mean time of 11.7m.Conclusion:A z-shaped osteotomy is an efficient and successful method to restore fibula length and rotation in patients with posttraumatic malunion. Our findings in this series of 19 ankles confirm that this realignment surgery results in significant pain relief and functional improvement.
|