To wedge or not to wedge; A cadaveric comparison study of two medial malleolar osteotomy modalities.

Autor: Veizi E; Ankara City Hospital, Department of Orthopedics and Traumatology, 06000 Ankara, Turkey. Electronic address: dr.nad89@hotmail.com., Çelik Z; Hacettepe University, Faculty of Medicine, Department of Anatomy, Ankara, Turkey., Güneş BE; Hacettepe University, Faculty of Medicine, Department of Anatomy, Ankara, Turkey., Beşer CG; Hacettepe University, Faculty of Medicine, Department of Anatomy, Ankara, Turkey., Demiryürek D; Hacettepe University, Faculty of Medicine, Department of Anatomy, Ankara, Turkey., Fırat A; Ankara City Hospital, Department of Orthopedics and Traumatology, 06000 Ankara, Turkey.
Jazyk: angličtina
Zdroj: Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons [Foot Ankle Surg] 2022 Dec; Vol. 28 (8), pp. 1248-1253. Date of Electronic Publication: 2022 May 26.
DOI: 10.1016/j.fas.2022.05.007
Abstrakt: Objective: To quantify the surface area of the talus accessible with a uniplanar and a biplanar medial malleolus osteotomy. Our secondary purpose study is to quantify the amount of weightbearing area that each osteotomy effects on the tibial articular surface.
Patients and Methods: Eight ankle joint specimens were dissected for this study. The uniplanar osteotomy was performed first. A K-wire marked the limits of access at two different angles: 90° and 30°. The boundaries were marked with a skin marker. Wedges were then created on the tibia plafond, and the osteotomy was converted into a biplanar one. Measurements were repeated again for this osteotomy. The talus, the tibial plafond, and the medial malleolus were then excised. Images were taken and then electronically calibrated for two-dimensional digital measurement of accessible areas. Areas of perpendicular and 30-degree access were recorded for both osteotomies. The articular surface of the tibia was also measured, and an area analysis was performed to calculate the amount of weightbearing cartilage removed by each osteotomy.
Results: Almost the entire sagittal plane was accessible with both osteotomies. At a 30° angle, bone purchase was achieved for 67.7 % of the talar articular surface with the uniplanar osteotomy and for 74.8 % with the biplanar osteotomy. At a 90° angle, uniplanar osteotomy provided access to 32.7 % of the talar articular area, whereas the biplanar osteotomy achieved an average coverage of 52.8 %. The difference was statistically significant. On average, 25.3 % of the weightbearing area of the tibial plafond is affected when a biplanar osteotomy is performed.
Conclusion: Medial malleolar osteotomy provides varying degrees of access to the talar dome depending on how it is performed. A wedge-shaped biplanar osteotomy provides greater access and is therefore more suitable for defects located deeper on the talar dome. Despite providing wider access, it results in greater disruption of the weightbearing cartilage of the tibial plafond.
Level of Evidence: Level V.
Competing Interests: Conflict of interest All the authors declare that they have no conflicts of interest regarding this study.
(Copyright © 2022 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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