[Prolongation osteotomy in the treatment of poorly healed fractures of the talocrural joint.].
The authors investigated possibilities and ways of reconstruction of the talar joint in poorly healed fractures associated with a lesion of the tibiofibular syndesmosis. The anatomical investigation revealed that for extension of the fork of the talus the proximal shift of the ankle is most important (9, 10) . A three-millimetre shift is sufficient to widen the fork of the talus by 5 - 6 mm which leads to severe instability and valgus position of the talus. In the widening of the fork of the talus participates in a minor way also axial valgus dislocation of the fibular ankle and its external rotation. Preoperative assessment of the proximal shift of the fibula will enable us to assess accurately in advance the required prolongation of the fibula. The crucial point of reconstruction of poorly healed bimaleolar fractures of the talus associated with a lesion of the syndesmosis is perfect restoration of the anatomical length of the fibula and congruence of tibiofibular syndesmosis (5, 8, 11). Reposition of the inner ankle is achieved after appropriate osteotomy spontaneously by pressure of the medially forward pushed talus. Key words: lengthening of the fibula, malunion of the ankle, reconstruction of the ankle.
Sosna
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Ortopedická klinika 1. lékarské fakulty UK, Praha.
Pinskerová
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V
Pokorný
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D