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Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 7/2011

Open Access 01-07-2011 | Orthopaedic Surgery

Direction of the oblique medial malleolar osteotomy for exposure of the talus

Authors: Christiaan J. A. van Bergen, Gabriëlle J. M. Tuijthof, Inger N. Sierevelt, C. Niek van Dijk

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 7/2011

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Abstract

Introduction

A medial malleolar osteotomy is often indicated for operative exposure of posteromedial osteochondral defects and fractures of the talus. To obtain a congruent joint surface after refixation, the oblique osteotomy should be directed perpendicularly to the articular surface of the tibia at the intersection between the tibial plafond and medial malleolus. The purpose of this study was to determine this perpendicular direction in relation to the longitudinal tibial axis for use during surgery.

Materials and methods

Using anteroposterior mortise radiographs and coronal computed tomography (CT) scans of 46 ankles (45 patients) with an osteochondral lesion of the talus, two observers independently measured the intersection angle between the tibial plafond and medial malleolus. The bisector of this angle indicated the osteotomy perpendicular to the tibial articular surface. This osteotomy was measured relative to the longitudinal tibial axis on radiographs. Intraclass correlation coefficients (ICC) were calculated to assess reliability.

Results

The mean osteotomy was 57.2 ± 3.2° relative to the tibial plafond on radiographs and 56.5 ± 2.8 on CT scans. This osteotomy corresponded to 30.4 ± 3.7° relative to the longitudinal tibial axis. The intraobserver (ICC, 0.90–0.93) and interobserver (ICC, 0.65–0.91) reliability of these measurements were good to excellent.

Conclusion

A medial malleolar osteotomy directed at a mean 30° relative to the tibial axis enters the joint perpendicularly to the tibial cartilage, and will likely result in a congruent joint surface after reduction.
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Metadata
Title
Direction of the oblique medial malleolar osteotomy for exposure of the talus
Authors
Christiaan J. A. van Bergen
Gabriëlle J. M. Tuijthof
Inger N. Sierevelt
C. Niek van Dijk
Publication date
01-07-2011
Publisher
Springer-Verlag
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 7/2011
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-010-1227-8

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