title: The role of fibular for supramalleolar osteotomy in treatment of varus ankle arthritis: a biomechanical and clinical study.
abstract: BACKGROUND
  Supramalleolar osteotomy (SMOT) is a well-accepted treatment method for mid-stage varus ankle osteoarthritis (OA). However, few studies have examined the role of fibular osteotomy in SMOT. The objective of the current study was to compare the biomechanical and clinical outcomes of SMOT with and without fibular osteotomy.
  
  
  METHODS
  Eight cadaveric lower legs with 10° varus/valgus SMOT models were tested using a Tekscan ankle sensor. Tibiotalar joint contact with and without fibular osteotomy conditions were compared. Forty-one varus ankle OA patients treated with SMOT were included; 22 underwent fibular osteotomy, and 19 did not. The Maryland foot score and radiological angles were used for clinical evaluation.
  
  
  RESULTS
  The mean contact area and pressure did not differ significantly between normal and varus/valgus conditions with the fibula preserved. After fibular osteotomy, the mean contact area decreased and the mean contact pressure increased significantly in varus and valgus conditions (P < 0.01). The loading center moved to the opposite direction with and without fibular osteotomy in varus/valgus conditions. After a mean follow-up of 36.6 months (range 17-61), there was no significant difference in the Maryland scores of the two groups. However, in the fibular osteotomy group, the talar tilt angle decreased (P < 0.05), and the tibiocrural angle improved significantly (P < 0.01).
  
  
  CONCLUSIONS
  Fibular osteotomy facilitates the translation of tibiotalar contact pressure and is helpful for varus ankle realignment in patients with large talar tilts and small tibiocrural angles.
authors: Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China.
authors: Hongmou
authors: H
authors: Zhao
authors: Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China. honghuizhm@163.com.
authors: Xiaojun
authors: X
authors: Liang
authors: Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China.
authors: Yi
authors: Y
authors: Li
authors: Foot and Ankle Surgery Department, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China.
authors: Guangrong
authors: G
authors: Yu
authors: Laboratory of Biomechanics, Tongji University School of Medicine, Shanghai, 200092, China.
authors: Wenxin
authors: W
authors: Niu
authors: Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China.
authors: Yan
authors: Y
authors: Zhang
mesh_terms: D000328:Adult; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001696:Biomechanical Phenomena; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Biomechanics; Realignment surgery; Supramalleolar osteotomy; Varus ankle arthritis