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OrthoBuzz: Protecting Surgeons’ Hands from Radiation during Fluoroscopy

Latest Surgical Technique

May 13, 2015
  • Tae-Keun Ahn , MD
  • Young Yi , MD
  • Jae-Ho Cho , MD
  • Woo-Chun Lee , MD, PhD
  1. Tae-Keun Ahn, MD1,
  2. Young Yi, MD2,
  3. Jae-Ho Cho, MD2 and
  4. Woo-Chun Lee, MD, PhD2
  1. 1Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 463-712, South Korea. E-mail address: ajh329@gmail.com
  2. 2Department of Orthopaedic Surgery, Seoul Foot and Ankle Center, Seoul Paik Hospital, Inje University, 85, 2-ga, Jeo-dong, Jung-gu, Seoul 100-032, South Korea. E-mail address for Y. Yi: 20vvin@naver.com. E-mail address for J.-H. Cho: hohotoy@nate.com. E-mail address for W.-C. Lee: leewoochun@gmail.com

Introduction 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.

Step 1: Patient Positioning and Preoperative Assessment With the patient under spinal or general anesthesia, check for mortise widening with a valgus stress test.

Step 2: Surgical Approach Expose the ankle joint through an anterior approach.

Step 3: Corrective Osteotomy Perform an oblique osteotomy of the distal part of the tibia and narrow the widened mortise by shifting the osteotomized fragment.

Step 4: Fixation and Bone-Grafting Stabilize the osteotomy site with a locking plate and apply bone graft to the osteotomy site.

Step 5: Closure Close the soft tissue in layers.

Results 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.

Indications

Contraindications

Pitfalls & Challenges

Introduction

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 (Video 1).

Video 1

Distal tibial osteotomy without fibular osteotomy.

The mortise structure of the ankle joint is a primary constraint that provides osseous medial and lateral stability. Loss of osseous stability of the ankle mortise accelerates degenerative changes. In patients with advanced medial ankle osteoarthritis, with obliteration of the medial joint space, the ankle mortise is often widened as a result of medial erosion due to medial translation of the talus. The widened mortise decreases ankle stability. The sole focus of most previously reported joint-sparing osteotomies for medial ankle osteoarthritis has been on shifting the …

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