Byron L. Hutchinson
Major advances in the understanding and treatment of the ankle during the past 30 years have improved prognosis after ankle fracture (1,2,3,4,5,6,7,8,9,10,11,12,13,14 and 15). Prior to 1950, the emphasis on treatment was on cast immobilization or reduction of the medial malleolus. Since then, the importance of anatomic alignment of the fibula has been realized to preserve joint contact and improve outcomes (16,17,18,19,20,21,22 and 23).
Malunions of the fibula can lead to posttraumatic arthrosis of the ankle if left untreated (24,25,26,27,28,29 and 30). Most patients with a malunion of the fibula develop a painful ankle joint that is treated symptomatically until the disability has become severe enough to warrant an ankle fusion or replacement.
Now that we are in the “age of joint preservation,” reconstructive surgical options that will delay or prevent the need for fusion or implant are popular. Early surgical intervention utilizing a fibular osteotomy to restore fibular length resulting in restoration of ankle joint congruency and stability is an effective alternative to arthrodesis or implant.
The reconstructive treatment of malunited ankle fractures has been underemphasized in the literature. Speed and Boyd (31) were the first to describe the importance of correcting malunion of the fibula as early as 1936. It was not until 1981 that Weber (32) popularized his transverse osteotomy to lengthen and derotate the fibula. In 1985, he reported good to excellent results in a retrospective analysis of 23 patients with an average follow-up of 11 years (33). Since that time, there have been several articles detailing various aspects of the procedure (34,35,36,37,38,39 and 40).