title: Classification and treatment of supramalleolar deformities.
abstract: BACKGROUND
  Supramalleolar osteotomies are increasingly popular for addressing asymmetric arthritis of the ankle joint. Still, recommendations for the indication and the use of additional procedures remain arbitrary. We preoperatively grouped different types of asymmetric arthritis into several classes and assessed the usefulness of an algorithm based on these classifications for determining the choice of supramalleolar operative procedure and the risk factors for treatment failure.
  
  
  METHODS
  Ninety-two patients (94 ankles) were followed prospectively and assessed clinically and radiographically 43 months after a supramalleolar osteotomy for asymmetric arthritis of the ankle joint.
  
  
  RESULTS
  Significant improvement of the clinical scores was found. Postoperative reduction of radiological signs of arthritis was observed in mid-stage arthritis. Age and gender did not affect the outcome. Ten ankles failed to respond to the treatment and were converted to total ankle replacements or fused.
  
  
  CONCLUSIONS
  Supramalleolar osteotomies can be effective for the treatment of early and midstage asymmetric arthritis of the ankle joint. However, certain subgroups have a tendency towards a worse outcome and may require additional surgery. Therefore preoperative distinction of different subgroups is helpful for determination of additional procedures.
authors.affiliation: Department of Orthopaedic Surgery, Kantonsspital Liestal, Liestal, Switzerland. markus.knupp@ksli.ch
authors.forename: Markus
authors.initials: M
authors.lastname: Knupp
authors.forename: Sjoerd A S
authors.initials: SA
authors.lastname: Stufkens
authors.forename: Lilianna
authors.initials: L
authors.lastname: Bolliger
authors.forename: Alexej
authors.initials: A
authors.lastname: Barg
authors.forename: Beat
authors.initials: B
authors.lastname: Hintermann
mesh_terms: D000368:Aged; D000465:Algorithms; D000843:Ankle Joint / Q000000981:diagnostic imaging; D001168:Arthritis / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D017211:Treatment Failure