Surgical treatment of post-traumatic malalignment of the ankle

Sandro Giannini, Cesare Faldini, Francesco Acri, Danilo Leonetti, Deianira Luciani, Matteo Nanni

Research output: Contribution to journalArticlepeer-review


Post-traumatic malalignment is evident in cases of malunion of ankle fractures. This condition predisposes to the development of chronic pain, functional impairment, and finally post-traumatic arthritis. The aim of this paper is to present a joint-saving surgical treatment of post-traumatic ankle malalignment. It is based on the review of a series of patients who developed fracture malunion and were treated with articular reconstruction. Twenty-two ankle fractures, which malunited and resulted into valgus deformity and fibular shortening are presented. Pre-reconstruction and mid-term follow-up evaluation included the AOFAS score and standard weight-bearing radiographs. Surgical treatment consisted in articular reconstruction with malleolar osteotomies. Post-operatively, the non-weight-bearing period extended to 6 weeks post-surgery, while full weight-bearing was allowed at 12 weeks on average. All osteotomies healed, while no intra-operative or early post-operative complications were reported. The average pre-operative AOFAS score was 45, while post-operatively climbed to 87. At the last follow-up, on average at 5-years post-surgery, 10 patients reported "excellent" function, 7 "good", 3 "fair" and 2 "poor" function. The correction of the malalignment was maintained in 20 cases. The two patients with poor function and loss of reduction underwent ankle fusion. Articular reconstruction with malleolar osteotomies is indicated for the treatment of ankle post-traumatic malalignment, offering reduction of pain, improvement of the ankle function, delaying the development of post-traumatic arthritis, and minimising the need of radical surgery such as ankle fusion or prosthetic replacement. Moreover, once a correct alignment of the joint is achieved, secondary surgery, if necessary, can be performed more easily, and with better results.

Original languageEnglish
Pages (from-to)1208-1211
Number of pages4
Issue number11
Publication statusPublished - Nov 2010


  • Ankle malalignment
  • Articular reconstruction
  • Joint salvage
  • Malleolar osteotomy
  • Post-traumatic ankle arthritis
  • Surgical treatment

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine


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