title: Safe Zone for Medial Open-Wedge Supramalleolar Osteotomy of the Ankle: A Cadaveric Study.
abstract: BACKGROUND
  The purpose of this present study was to determine the incidence of lateral cortical fracture depending on the plane of osteotomy in medial open-wedge supramalleolar osteotomy (SMO) and to define a safe zone through which a medial open-wedge SMO could be performed with minimal risk of lateral cortical fracture.
  
  
  METHODS
  Matched pairs of fresh-frozen human cadaver lower leg specimens were obtained from 7 males and 3 females (average age = 63.9 [range 49-75] years). In group A, a safe zone-level medial open-wedge SMO (plane of osteotomy oriented to the proximal one-third of the intrasyndesmosis) was performed, and in group B, a higher-level medial open-wedge SMO (plane of osteotomy oriented to the suprasyndesmosis) was performed.
  
  
  RESULTS
  In group A, 7 of the 10 limbs had no lateral cortical fracture, and 3 had lateral cortical fracture, but all of the fractured limbs were stable during the medial open-wedge SMO procedure. In group B, 2 of 10 limbs had no lateral cortical fracture and 8 had lateral cortical fracture. Three of the 8 fractured limbs were stable, but 5 were unstable during the medial open-wedge SMO procedure. The incidence of lateral cortical fracture in group B was significantly higher compared to group A (P = .04).
  
  
  CONCLUSIONS
  According to the present findings, lateral cortical fracture was less likely to occur when open-wedge SMO was at the plane of the proximal one-third of the intrasyndesmosis, the so-called "safe zone," than at the plane of the suprasyndesmosis.
  
  
  CONCLUSIONS
  A safe zone for medial open-wedge SMO to prevent lateral cortical fracture during the medial open-wedge SMO procedure was identified.
authors.affiliation: Department of Orthopedic Surgery, Inje University Ilsanpaik Hospital, Republic of Korea.
authors.forename: Kyung Wook
authors.initials: KW
authors.lastname: Nha
authors.affiliation: Department of Orthopedic Surgery, Korea University Anam Hospital, Republic of Korea.
authors.forename: Soon Hyuck
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Anatomy, College of Medicine, Korea University, Republic of Korea.
authors.forename: Im Joo
authors.initials: IJ
authors.lastname: Rhyu
authors.affiliation: Department of Orthopedic surgery, Korea University Guro Hospital, Republic of Korea.
authors.forename: Hak Jun
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Inje University Ilsanpaik Hospital, Republic of Korea.
authors.forename: Jae Gwang
authors.initials: JG
authors.lastname: Song
authors.affiliation: Department of Orthopedic Surgery, Inje University Ilsanpaik Hospital, Republic of Korea.
authors.forename: Jae Hwi
authors.initials: JH
authors.lastname: Han
authors.affiliation: Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Republic of Korea.
authors.forename: Eui Dong
authors.initials: ED
authors.lastname: Yeo
authors.affiliation: Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Republic of Korea brain0808@hanmail.net.
authors.forename: Young Koo
authors.initials: YK
authors.lastname: Lee
mesh_terms: D000368:Aged; D064386:Ankle Fractures / Q000209:etiology / Q000517:prevention & control*; D000843:Ankle Joint / Q000601:surgery*; D002102:Cadaver; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D015203:Reproducibility of Results; D013977:Tibia / Q000601:surgery*
keywords: lateral cortical fracture; plane of osteotomy; safe zone; supramalleolar osteotomy