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Ankle joint re-balancing in the management of ankle fracture malunion using fibular lengthening: prospective clinical-radiological results at mid-term follow-up

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Abstract

Purpose

An unsatisfactory reduction and internal fixation of an ankle fracture can result in an alteration of the anatomical axes and distribution of the load on the ankle, with consequent development of chronic pain and articular degeneration. The aim of this study is to evaluate the results of the articular re-balancing with realignment and lengthening of the fibula in case of malunited distal fibular fractures.

Methods

A review of prospectively collected data was performed for all patients with a diagnosis of malunion of the fibula and underwent ankle joint re-balancing with fibular lengthening. Twenty-three patients, with a mean age of 39.4 ± 13.1 years, have been evaluated using radiographic parameters, American Orthopaedic Foot and Ankle Surgeons ankle-hindfoot, Ankle Activity scale, and SF-36 score at six, 12, 24, and 36 months post-operatively.

Results

All cases treated showed at follow-up the osteotomy healed in good correction of the deformities. Clinical scores showed a clear improvement: final 36-month mean AOFAS was 74.0 ± 8.9 point, final 36-month mean HALASI score was 4.9 ± 0.9 points, 36-month follow-up SF-36 score showed an average score of 73.2 ± 10.7 points. Pre- and post-operative radiographic parameters have been registered and described.

Conclusions

The ankle joint is a complex structure, and even minor changes of the structure of this joint can significantly compromise its functionality. Ankle joint re-balancing is an effective surgical procedure in case of fibular malunion. This procedure, in patients carefully selected, could procrastinate more disabling surgical procedure, as arthrodesis or prosthesis.

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Acknowledgements

Authors would like to thank Dr. Maria Pia Cumani from Scuola di Disegno Anatomico, Rizzoli Orthopaedic Institute (Bologna, Italy) for artwork and figures.

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Authors and Affiliations

  1. II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Massimiliano Mosca, Mario Fuiano, Emanuele Vocale, Simone Massimi, Alberto Grassi, Silvio Caravelli & Stefano Zaffagnini

  2. Dipartimento di Medicina e Scienze dell’Invecchiamento, Università degli Studi “G. D’Annunzio”, Chieti, Italy

    Roberto Buda

  3. Clinica Ortopedica, Azienda ospedaliero-universitaria Parma, Parma, Italy

    Francesco Ceccarelli

  4. Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Maria Grazia Benedetti

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  1. Massimiliano Mosca
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  2. Roberto Buda
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Correspondence to Silvio Caravelli.

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Mosca, M., Buda, R., Ceccarelli, F. et al. Ankle joint re-balancing in the management of ankle fracture malunion using fibular lengthening: prospective clinical-radiological results at mid-term follow-up. International Orthopaedics (SICOT) 45, 411–417 (2021). https://doi.org/10.1007/s00264-020-04690-y

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