title: Realignment Surgery for Malunited Ankle Fracture.
abstract: OBJECTIVE
  To investigate the characteristics and the results of realignment surgery for the treatment of malunited ankle fracture.
  
  
  METHODS
  Thirty-three patients with malunited fractures of the ankle who underwent reconstructive surgery at our hospital from January 2010 to January 2014 were reviewed. The tibial anterior surface angle (TAS), the tibiotalar tilt angle (TTA), the malleolar angle (MA), and the tibial lateral surface angle (TLS) were measured. Clinical assessment was performed with use of the American Orthopaedic Foot and Ankle Society (AOFAS) scale and visual analogue scale (VAS) scores, and the osteoarthritis stage was determined radiographically with the modified Takakura classification system. The Wilcoxon matched-pairs test was used to analyze the difference between the preoperative and the postoperative data.
  
  
  RESULTS
  The mean follow-up was 36 months (range, 20-60 months). The mean age at the time of realignment surgery was 37.1 years (range, 18-62 years). Compared with preoperation, the TAS at the last follow-up showed a significant increase (88.50° ± 4.47° vs. 90.80° ± 3.49°, P = 0.0035); similar results were observed in TTA (1.62° ± 1.66° vs. 0.83° ± 0.90°, P < 0.01) and MA (82.30° ± 8.03° vs. 78.70° ± 4.76°, P = 0.005). At the last follow-up, the mean AOFAS score was significantly increased compared with the score at preoperation (44.5 ± 13.7 vs. 78.0 ± 8.9, P < 0.01). Significant differences in VAS scores were found at the last follow-up (6.76 ± 1.03 vs. 2.03 ± 1.21, P < 0.01). There was no significant difference in the Takakura grade between the preoperation and the last follow-up. One patient had increased talar tilt postsurgery; the postoperative talar tilt angle of this patient was 20°. One patient had progressive ankle osteoarthritis, and was treated by ankle joint distraction.
  
  
  CONCLUSIONS
  Realignment surgery for a malunited ankle fracture can reduce pain, improve function, and delay ankle arthrodesis or total ankle replacement. Postoperative large talar tilt and advanced stages of ankle arthritis are the risk factors for the surgery.
authors.affiliation: Department of Orthopaedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.|Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Chang-Jun
authors.initials: CJ
authors.lastname: Guo
authors.affiliation: Department of Orthopaedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Xing-Cheng
authors.initials: XC
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Mu
authors.initials: M
authors.lastname: Hu
authors.affiliation: Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Orthopaedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.|Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Xiang-Yang
authors.initials: XY
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D016916:Joint Deformities, Acquired / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D011859:Radiography; D055815:Young Adult
keywords: Clinical outcomes; Malunited ankles; Reconstruction operation