Distal Tibial Osteotomy without Fibular Osteotomy for Medial Ankle Arthritis with Mortise Widening.

Abstract

A patient with medial ankle osteoarthritis and a widened ankle mortise can be treated successfully with an oblique distal tibial osteotomy, without fibular osteotomy, to narrow the mortise and shift the weight-bearing axis to a more normal position. With the patient under spinal or general anesthesia, check for mortise widening with a valgus stress test. Expose the ankle joint through an anterior approach. Perform an oblique osteotomy of the distal part of the tibia and narrow the widened mortise by shifting the osteotomized fragment. Stabilize the osteotomy site with a locking plate and apply bone graft to the osteotomy site. Close the soft tissue in layers. Eighteen patients (fifteen female and three male; mean age, fifty-seven years) with symptomatic medial ankle osteoarthritis and mortise widening underwent distal tibial oblique osteotomy without fibular osteotomy between 2008 and 2011.IndicationsContraindicationsPitfalls & Challenges.