Korrektur posttraumatischer Fehlstellungen der distalen Tibia mithilfe der fokalen Domosteotomie

Thomas Rosteius, Hinnerk Baecker, Thomas Armin Schildhauer, Dominik Seybold, Jan Geßmann

Supramalleolar deformities require surgical correction to avoid posttraumatic osteoarthrosis of the knee or ankle joint and to prevent definitive treatment options, such as total ankle arthroplasty or arthrodesis of the ankle joint. Various methods for the operative correction of supramalleolar deformities have been described in the literature. What results can be achieved with focal dome osteotomy to correct posttraumatic supramalleolar deformities? A total of 10 patients (mean age 37 years) with a supramalleolar posttraumatic deformity were treated by focal dome osteotomy. The mean follow-up was 27 months (min. 6, max. 105 months), 5 patients were female and 5 male. The supramalleolar varus/valgus deformity was on average 20° (at least 12°, maximum 33°). Preoperative and postoperative mechanical axis and joint angles were determined on digital radiographs. The American Orthopedic Foot and Ankle Society (AOFAS) score was used to assess the clinical outcome. In seven patients the anatomical leg axis could be restored. In three patients a residual deformity of 2.8° was observed. Bone grafting was not necessary in any of the cases. Of the patients eight had free ankle mobility and two showed an average movement limit of 30° compared to the contralateral side. Posttraumatic ankle arthrosis was not observed in the short-term and medium-term results. The mean AOFAS score of 80 points (minimum 70, maximum 98) documented a functionally good result. Supramalleolar dome type osteotomy is a technically difficult method for acute correction of supramalleolar deformities. The functional results and complication rates are comparable to those in the literature for alternative osteotomy techniques.