title: Syndesmosis preserving osteotomy of the fibula for access to the lateral talar dome.
abstract: BACKGROUND
  Open surgical access to the postero-lateral talar dome for the treatment of osteochondral lesions is challenging, often requiring a segmental osteotomy of the fibula (fibular window) and division of the anterior inferior tibiofibular ligament (AITFL) or a fibular osteotomy with division of the AITFL and the anterior talofibular ligament (ATFL) (fibular door). Alternatively, to preserve the tibiofibular syndesmosis both the fibula and the lateral tibial plafond can be osteotomised to expose the entire lateral talar dome. All of these techniques involve extensive surgical exposures and a significant amount of internal fixation of the osteotomy to achieve surgical access.
  
  
  METHODS
  A trapezoidal fibular osteotomy which hinges on the AITFL thus preserving the syndesmotic and lateral ligamentous complex was developed to permit perpendicular access to the lateral talar dome. The remaining posterior column of fibula allows keying in of the osteotomy requiring minimal internal fixation.
  
  
  RESULTS
  A 43 year old male with a displaced osteochondral fracture of the superolateral talar dome underwent the osteotomy to provide perpendicular fixation with two Herbert's screws. The osteotomy was reduced and fixed with a single 3.5mm lag screw. At 3 month follow up the osteotomy had healed both clinically and radiographically.
  
  
  CONCLUSIONS
  Our technique utilizes a novel trapezoidal fibular osteotomy with preservation of key syndesmotic and ligamentous structures and requires minimal internal fixation.
authors: Department of Trauma and Orthopaedic Surgery, Bart's Health, NHS Trust, London, United Kingdom. Electronic address: kalpeshrvaghela@gmail.com.
authors: Kalpesh R
authors: KR
authors: Vaghela
authors: Department of Trauma and Orthopaedic Surgery, AUVA Unfallkrankenhaus, Graz, Austria.
authors: Hans
authors: H
authors: Clement
authors: Department of Trauma and Orthopaedic Surgery, Bart's Health, NHS Trust, London, United Kingdom.
authors: Lee
authors: L
authors: Parker
mesh_terms: D000328:Adult; D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005360:Fibula / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods*; D013628:Talus / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: Anterior inferior tibiofibular ligament (AITFL); Fibular osteotomy; Osteochondral fracture; Osteochondral lesion of talus; Syndesmosis; Talar dome