Supramalleolar Osteotomy Using Circular External Fixation with Six-Axis Deformity Correction of the Distal Tibia

Abstract

Background: Supramalleolar osteotomy using circular external fixation with six-axis deformity correction is a rarely reported treatment method particularly well-suited for complex multidimensional deformities of the adult ankle. The purpose of this study was to assess the accuracy of deformity correction and change in functional status using this technique. Methods: We present a retrospective review of 52 patients who underwent supramalleolar osteotomy with application of the Taylor Spatial Frame (Smith & Nephew, Memphis, TN). Mean age was 44 (range, 18 to 79) years. The primary outcome was change in preoperative to postoperative distal tibial joint orientation angles. Coronal and sagittal plane joint orientation angles were measured for all 52 enrolled patients. The secondary outcome was change in AOFAS scores which were available for 31 patients. Results: Twenty-two patients had oblique plane deformities. The mean time in frame was 4 (range, 2 to 11) months, and patients were followed for a mean of 14 months after frame removal. All aggregate postoperative distal tibial angles underwent a significant improvement (p < 0.05) and were within 0 degrees to 4 degrees of normal in the various deformity groups. Average preoperative AOFAS score was 40 (range, 12 to 67) and average postoperative AOFAS score was 71 (range, 34 to 97; p < 0.001). Complications included two patients with nonunions at the osteotomy site that healed with further treatment. Three patients went on to have ankle fusion. Conclusion: We feel that supramalleolar osteotomy using circular external fixation with six-axis deformity correction was an effective method for correction of distal tibial deformities in the adult population, particularly for those patients with complex oblique-plane deformities, associated rotational deformity, a compromised soft tissue envelope, or a prior history of infection.

Level of Evidence: IV, Retrospective Case Series

Keywords

Ilizarov External Fixation Ankle Arthritis Tibia Malunion

Get full access to this article

View all access options for this article.

References

1. Aqui

Thiryayi

Foster

: Correction of simple and complex pediatric deformities using the Taylor-Spatial Frame. J Pediatr Orthop. 28:640–647, 2008.https://dx-doi-org.web.bisu.edu.cn/10.1097/BPO.0b013e3181831e99.

2. Benthien

Myerson

: Supramelleolar osteotomy for ankle deformity and arthritis. Foot Ankle Clin. 9(3):475–87, 2004. https://dx-doi-org.web.bisu.edu.cn/10.1016/j.fcl.2004.05.012.

3. Eidelman

Bialik

Katzman

: Correction of deformities in children using the Taylor spatial frame. J Pediatr Orthop B. 15:387–395, 2006. https://dx-doi-org.web.bisu.edu.cn/10.1097/01.bpb.0000228380.27239.8a.

4. Elomrani

Kasis

Tis

: Outcome after foot and ankle deformity correction using circular external fixation. Foot Ankle Int. 26:1027–32, 2005.

5. Feldman

Madan

Koval

: Correction of tibia vara with six-axis deformity analysis and the Taylor spatial frame. J Pediatr Orthop. 23:387–391, 2003. https://dx-doi-org.web.bisu.edu.cn/10.1097/01241398-200305000-00022.

6. Feldman

Madan

Ruchelsman

: Accuracy of correction of tibia vara: acute versus gradual correction. J Pediatr Orthop. 26:794–798, 2006. https://dx-doi-org.web.bisu.edu.cn/10.1097/01.bpo.0000242375.64854.3d.

7. Feldman

Shin

Madan

: Correction of tibial malunion and nonunion with six-axis analysis deformity correction using the Taylor spatial frame. J Orthop Trauma. 17:549–554, 2003. https://dx-doi-org.web.bisu.edu.cn/10.1097/00005131-200309000-00002.

8. Fragomen

Rozbruch

: Proximal Tibial Osteotomy for Medial Compartment osteoarthritis of the Knee Using the Taylor Spatial Frame. Techniques in Knee Surgery. 4(3):173–185, 2005. https://dx-doi-org.web.bisu.edu.cn/10.1097/01.btk.0000175882.99745.a3.

9. Ganger

Radler

Speigner

: Correction of post-traumatic lower limb deformities using the Taylor spatial frame. International Orthopaedics. 34:723–730, 2010. https://dx-doi-org.web.bisu.edu.cn/10.1007/s00264-009-0839-5.

10.

10. Graehl

Hersh

Heckman

: Supramalleolar osteotomy for the treatment of symptomatic tibial malunion. J Orthop Trauma. 1:281–292, 1987. https://dx-doi-org.web.bisu.edu.cn/10.1097/00005131-198701040-00003.

11.

11. Harstall

Lehmann

Krause

: Supramalleolar lateral closing wedge osteotomy for the treatment of varus ankle arthrosis. Foot Ankle Int. 28(5):542–548, 2007. https://dx-doi-org.web.bisu.edu.cn/10.3113/FAI.2007.0542.

12.

12. Ilizarov

: The tension-stress effect on the genesis and growth of tissues. Part 1 The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res. 238:249–281, 1989.

13.

13. Ilizarov

: The tension-stress effect on the genesis and growth of tissues: Part II. The influence of the rate and frequency of distraction Clin Orthop Relat Res. 239:263–85, 1989.

14.

14. Lee

Cho

Oblique Supramalleolar Opening Wedge Osteotomy Without Fibular Osteotomy for Varus Deformity of the Ankle

Foot Ankle Int. 30(6):565–67, 2009. https://dx-doi-org.web.bisu.edu.cn/10.3113/FAI.2009.0565.

15.

15. Matsubara

Tsuchiya

Takato

: Correction of ankle ankylosis with deformity using the Taylor spatial frame. Foot Ankle Int. 28(12):1290–93, 2007.

16.

16. McKinley

Rudert

Koos

: Pathomechanic determinants of posttraumatic arthritis. Clin Orthop Relat Res. 427:S78-S88, 2004. https://dx-doi-org.web.bisu.edu.cn/10.1097/01.blo.0000143817.74887.55.

17.

17. Nakase

Kitano

Kawai

: Distraction Osteogenesis for correction of three- dimensional deformities with shortening of lower limbs by Taylor Spatial Frame. Archives of Orthopaedic and Trauma Surgery. 129(9):1197–201, 2009. https://dx-doi-org.web.bisu.edu.cn/10.1007/s00402-008-0702-y.

18.

18. Nho

Helfet

Rozbruch

: Temporary intentional leg shortening and deformation to facilitate wound closure using the Ilizarov/Taylor spatial frame. J Orthop Trauma. 20:419–424, 2006. https://dx-doi-org.web.bisu.edu.cn/10.1097/00005131-200607000-00010.

19.

19. Paley

: Principles of Deformity Correction, New York, Springer, 2002.

20.

20. Rozbruch

: Percutaneous Supramalleolar osteotomy Using the Ilizarov/ Taylor spatial frame. In: Scuderi

Tria

: Minimally Invasive Surgery in Orthopaedics; Springer, New York 2010. https://dx-doi-org.web.bisu.edu.cn/10.1007/978-0-387-76608-9_55.

21.

21. Rozbruch

: Posttraumatic reconstruction of the ankle using the Ilizarov method. HSS J 1:68–88, 2005. https://dx-doi-org.web.bisu.edu.cn/10.1007/s11420-005-0113-3.

22.

22. Rozbruch

Fragomen

Ilizarov

: Correction of Tibial Deformity with Use of the Ilizarov Taylor spatial frame. Journal of Bone and Joint Surgery Am. 88(suppl 4):156–74, 2007. https://dx-doi-org.web.bisu.edu.cn/10.2106/JBJS.F.00745.

23.

23. Rozbruch

Helfet

Blyakher

: Distraction of hypertrophic nonunion of tibia with deformity using Ilizarov/Taylor spatial frame: report of two cases. Arch Orthop Trauma Surg. 122:295–29, 2002. https://dx-doi-org.web.bisu.edu.cn/10.1007/s00402-001-0370-7.

24.

24. Rozbruch

Segal

Ilizarov

: Does the Taylor spatial frame Accurately Correct Tibial Deformities?. Clin Orthop Relat Res. 468(5):1352–61, 2010. https://dx-doi-org.web.bisu.edu.cn/10.1007/s11999-009-1161-7.

25.

25. Siapkara

Nordin

Hill

: Spatial frame correction of anterior growth arrest of the proximal tibia: report of three cases. J Pediatr Orthop B. 17:61–64, 2008. https://dx-doi-org.web.bisu.edu.cn/10.1097/BPB.0b013e3282f56dc1.

26.

26. Stamatis

Cooper

Myerson

: Supramalleolar osteotomy for the treatment of distal tibial angular deformities and arthritis of the ankle joint. Foot Ankle Int. 24(10):754–764, 2003.

27.

27. Stamatis

Myerson

: Supramalleolar osteotomy: indications and technique. Foot Ankle Clin. 8(2):317–33, 2003. https://dx-doi-org.web.bisu.edu.cn/10.1016/S1083-7515(03)00018-4.

28.

28. Takakaru

Takaoka

Tanaka

: Results of opening wedge osteotomy for the treatment of a post-traumatic varus deformity of the ankle. J. Bone Joint Surg. 80-A:213–218, 1998.

29.

29. Takakaru

Tanaka

Kumai

: Low tibial osteotomy for osteoarthritis of the ankle: Results of a new operation in 18 patients. J. Bone Joint Surg. 77-B:50–54, 1995.

30.

30. Teeny

Wiss

: Open reduction and internal fixation of tibial plafond fractures: Variables contributing to poor results and complications. Clin Orthop Relat Res. 292:108–117, 1993.

31.

31. Tellisi

Fragomen

Ilizarov

: Lengthening and reconstruction of congenital leg deficiencies for enhanced prosthetic wear. Clin Orthop Relat Res. 466:495–499, 2008. https://dx-doi-org.web.bisu.edu.cn/10.1007/s11999-007-0041-2.

32.

32. Thordarson

: Complications after treatment of tibial pilon fractures: prevention and management strategies. J Am Acad Orthop Surg. 8:253–265, 2000.

33.

33. Thordarson

Motamed

Hedman

: The effect of fibular malreduction on contact pressures in an ankle fracture malunion model. J Bone Joint Surg Am. 80:1395–1396, 1998.