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. The purpose of this study was to compare the clinical, radiological, and secondlook. The purpose of this study was to compare the clinical. Pdf supramalleolar osteotomies for the treatment of ankle. Supramalleolar osteotomy in posttraumatic valgus ankle. We found that supramalleolar derotation osteotomy of the tibia, with aoasif t plate fixation is an effective method for the correction of torsional deformities of the tibia and the associated disturbances of gait in children and adults with neuromuscular disease, with a 5. It is controversial whether supramalleolar osteotomy is suitable for takakura stage 3b osteoarthritis or not. T1 changes in ankle joint motion after supramalleolar osteotomy. Ten lower leg specimens below the knee were prepared from freshfrozen human cadavers. 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.
Jun 01, 2006 supramalleolar osteotomy in the management of the rheumatoid hindfoot. Ankle distraction and supramalleolar osteotomy for arthrosis. A closer look at the distal tibial osteotomy for ankle varus. Accurate evaluation of the distal tibial deformity, weightbearing radiographs, and soft. We assessed the changes in motion of ankle joint and plantar pressure after supramalleolar osteotomy without fibular osteotomy. Dec 26, 2014 the followup xrays showed a distal tibia valgus deformity that was interpreted as a posttraumatic tibial malunion.
The most common etiology in patients with ankle osteoarthritis is posttraumatic often resulting in asymmetric ankle osteoarthritis with concomitant valgus or varus deformity. Supramalleolar osteotomy using circular external fixation. 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. This is supramalleolar osteotomy juxtaarticular deformity 30 sec demo by ian ryan interactive on vimeo, the home for high quality videos and the people.
Ankle distraction and supramalleolar osteotomy for. Medial openwedge supramalleolar osteotomy for patients with. The annals of the royal college of surgeons of england, 1015, pp. Pdf supramalleolar osteotomies for the treatment of. Seventeen children with down syndrome nine males, eight females. Supramalleolar osteotomies for degenerative joint disease of. Aug 20, 20 patients with varus or valgus hindfoot deformities usually present with asymmetric ankle osteoarthritis.
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. The followup xrays showed a distal tibia valgus deformity that was interpreted as a posttraumatic tibial malunion. Supramalleolar osteotomies for the treatment of ankle. Smos may have a left or right foot sticker on the bottom of the device. Pdf supramalleolar osteotomy is a jointpreserving surgical treatment for patients with asymmetric valgus or varus ankle arthritis. Pdf supramalleolar derotation osteotomy of the tibia. Singlestage supramalleolar osteotomy for coronal plane deformity. A supramalleolar osteotomy smo was offered to the patient to correct the deformity. Weightbearingline analysis in supramalleolar osteotomy for. 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.
Although supramalleolar osteotomy is a conservative therapeutic surgical option in patients with tibiotalar arthritis with hind foot alignment. Ankle arthrodesis is indicated for painful arthroses, instability, malalignment, and joint sepsis. Weightbearingline analysis in supramalleolar osteotomy for varustype osteoarthritis of the ankle keywords. Singlestage supramalleolar osteotomy for coronal plane. Operative treatment of flatfoot by supramalleolar osteotomy. 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 for the treatment of distal tibial angular deformities and arthritis of the ankle joint.
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 for the treatment of distal tibial angular deformities and arthritis of the ankle joint emmanouil d. 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. Supramalleolar osteotomy juxtaarticular deformity 30 sec. Once the suture is passed, the gigli saw is tied to. From february 2008 to august 20, supramalleolar osteotomy was performed in 21 patients matching the inclusion criteria. Although supramalleolar osteotomy is the main jointpreserving method for the treatment of varus ankle osteoarthritis, it tends to be. 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 total of 16 patients with asymmetric ankle osteoarthritis and concomitant. Safe zone for medial openwedge supramalleolar osteotomy. 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 role of fibular for supramalleolar osteotomy in treatment.
Changes in ankle joint motion after supramalleolar. A variety of surgical procedures are utilized for management of ankle osteoarthritis. The use of supramalleolar osteotomies in posttraumatic. Jun 21, 2016 on this page you can read or download cpt code for supramalleolar osteotomy in pdf format. The main indication for the supramalleolar osteotomy is asymmetric ankle osteoarthritis with concomitant supramalleolar valgus or varus deformity. If you dont see any interesting for you, use our search form on bottom v. The purpose of this study was to present a new surgical technique, supramalleolar osteotomy combined with lateral ligament reconstruction and talofibular. The role of fibular for supramalleolar osteotomy in.
Supramalleolar osteotomy for the treatment of distal. Additional mesenchymal stem cell injection improves the. Multiplanar supramalleolar osteotomy in the management of. Supramalleolar tibial osteotomy combined with fibular osteotomy was performed in sixteen ankles sixteen patients to treat moderate medial ankle osteoarthritis. Ankle distraction is utilized to fill areas of eburnated bone with a layer of cartilagelike matrix and. Supramalleolar osteotomy for unilateral tibial torsion. Safe zone for medial openwedge supramalleolar osteotomy of. A positive sidewalk sign disappearance of pain was correlated with a good outcome and had a positive predictive value of 0.
When combined, these techniques may be synergistic, providing further improved results. For a medial open wedge supramalleolar osteotomysmo, there are some debates as to whether concurrent fibular osteotomy should be performed. Patients with varus or valgus hindfoot deformities usually present with asymmetric ankle osteoarthritis. We present the results of an osteotomy performed at the supramalleolar level leaving the fibula intact and held with staples. Supramalleolar definition of supramalleolar by medical. Oct 24, 2016 supramalleolar osteotomy smot is a wellaccepted treatment method for midstage varus ankle osteoarthritis oa. Book pdf ocr text metadata dublin core national library of medicine. 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. Supramalleolar osteotomy in the management of the rheumatoid hindfoot. We found that supramalleolar derotation osteotomy of the tibia, with aoasif t plate fixation is an effective method for the correction of torsional deformities of the. Arthroscopic evaluation of persistent pain following. Jan 10, 2020 to assess how the level of the deformity, the stage of the osteoarthritic process, and the role of additional surgeries impact radiographic and clinical outcomes following an extraarticular medial closing supramalleolar osteotomy for treatment of posttraumatic valgus ankle osteoarthritis. About 56 consecutive patients who underwent an extraarticular medial closing. Supramalleolar tibial osteotomy secured with the puddu plate.
Supramalleolar osteotomy smot is a wellaccepted treatment method for midstage varus ankle osteoarthritis oa. Supramalleolar derotation osteotomy of the tibia, with t. The aim of this study was to evaluate the outcomes of supramalleolar osteotomy in patients with takakura 3b osteoarthritis. Learn more about how to use your supramalleolar orthosis smo. Technique guidance fully utilizing the saw blade jaclyn m.
A substantial part of tibiotalar joint is often preserved, therefore, in appropriate patients, joint. Although supramalleolar osteotomy is the main jointpreserving method for the treatment of varus ankle osteoarthritis, it tends to be ineffective when ankle osteoarthritis presents in combination with an excessive talar tilt angle. Malalignment of the ankle joint has been found after trauma, by neurological disorders, genetic. Supramalleolar osteotomies for ankle osteoarthritis. About 56 consecutive patients who underwent an extraarticular medial closing wedge osteotomy for post. Six osteotomies were performed for internal tibial torsion mean 25 and seven for external tibial torsion mean 25. 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. To assess how the level of the deformity, the stage of the osteoarthritic process, and the role of additional surgeries impact radiographic and clinical outcomes following an extraarticular medial closing supramalleolar osteotomy for treatment of posttraumatic valgus ankle osteoarthritis. 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.
Research article open access changes in ankle joint motion after supramalleolar osteotomy. Supramalleolar dome osteotomy for malunion of the tibia. 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. The aim of this prospective study was to analyze shortterm clinical and radiographic outcomes in patients with asymmetric ankle osteoarthritis. The purpose of this study was to present a new surgical technique, supramalleolar osteotomy combined with lateral ligament. Supramalleolare osteotomie bei asymmetrischer arthrose des. When varus osteotomy was combined with fibular osteotomy, mean cop. Supramalleolar osteotomy for moderate degenerative ankle.
Medial openwedge supramalleolar osteotomy for patients. Supramalleolar osteotomy combined with lateral ligament. Supramalleolar osteotomies for degenerative joint disease. The patient started with pain at the ankle approximately 10 years after the accident. Arthrex medializing calcaneal osteotomy using the step.
Other osseous realignment below the ankle soft tissue balancing make the osteotomy as close to the cora as possible varus opening wedge or dome. Supramalleolar osteotomy is designed to correct the medial displacement of the load line, laterally distributing the medial concentration of stress within the ankle joint 21, providing favorable. Nov 28, 2019 although supramalleolar osteotomy is the main jointpreserving method for the treatment of varus ankle osteoarthritis, it tends to be ineffective when ankle osteoarthritis presents in combination with an excessive talar tilt angle. Fleming, dpm the medial malleolar osteotomy mmo is frequently performed for adequate access of the medial talar dome in the surgical treatment of talar body fractures and osteochondral lesions. Effects of supramalleolar orthoses on postural stability. We assessed the changes in motion of ankle joint and plantar. Download cpt code for supramalleolar osteotomy document. May 27, 2017 supramalleolar osteotomy with external fixation perspective 2 ankle arthrodesis remains the gold standard for ankle arthritis. Supramalleolar osteotomy is an alternative surgical procedure for the management of asymmetric early arthritis of. Supramalleolar osteotomy smo is reported to be an effective treatment for varus ankle osteoarthritis by redistributing the load line within the ankle joint.
Correction of thigh foot angle and foot progression. Changes in ankle joint motion after supramalleolar osteotomy. Supramalleolar osteotomy combined with an intraarticular. 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. Although supramalleolar osteotomy is a conservative therapeutic surgical option in patients with. Supramalleolar osteotomy combined with an intraarticular osteotomy for the reconstruction of malunited medial impacted ankle fractures changjun guo, md, zongbao liu, md, yangbo xu, md, xingchen li, md, yuan zhu, md, and xiangyang xu, md.
Many authors have looked at the use of ilizarov external fixators for the correction of complex foot deformities. Supramalleolar osteotomy with external fixation perspective 2. Effect of a supramalleolar osteotomy in a novel asymmetric. The underlying diagnosis of the patients included seven severely rigid idiopathic clubfeet, five arthrogryposis, two myelodysplasia, one ellisvan creveld, one streeters, one cerebral palsy, and one severe burn contracture. The sticker indicates the correct foot the device goes on, even if they appear to be wrong. Ankle distraction arthroplasty and supramalleolar osteotomy have been independently shown to improve pain and function for patients with ankle arthritis.
Pdf supramalleolar osteotomy combined with lateral. Eight cadaveric lower legs with 10 varusvalgus smot models were tested. Another important indication for realignment osteotomies are isolated osteochondral lesion of the medial or lateral aspect of. Supramalleolar osteotomy for posttraumatic malunion, developmental or physeal deformities, congenital malalignment, or focal. A vertical second incision is made where the skin is tented by the extension of the periosteal elevator, and the elevator is removed. 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. A substantial part of tibiotalar joint is often preserved, therefore, in appropriate patients, jointpreserving surgery holds the.
Supramalleolar osteotomy is a jointpreserving surgical treatment for patients with asymmetric valgus or varus ankle arthritis. Tibial rotational osteotomy for idiopathic torsion. A novel technique for supramalleolar osteotomy of the. Supramalleolar osteotomy for ankle deformity and arthritis. On this page you can read or download cpt code for supramalleolar osteotomy in pdf format. For a medial open wedge supramalleolar osteotomy smo, there are some debates as to whether concurrent fibular osteotomy should be performed. Supramalleolar osteotomies for ankle osteoarthritis request pdf. Weightbearingline analysis in supramalleolar osteotomy. Supramalleolar osteotomy for tibiotalar varus malalignment. Prevent ankle arthritis treat ankle arthritis improve alignment for a fusion or replacement may need to combine with. However, few studies have examined the role of fibular osteotomy in smot.
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