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Fibular-Lengthening Osteotomy to Correct a Malunited Ankle Fracture Using Fresh-Frozen Femoral Head Allograft

A Case Study

Harry J. Visser Department of Podiatry, SSM Health DePaul Hospital, St. Louis, MO.

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Khawar Malik Department of Podiatry, SSM Health DePaul Hospital, St. Louis, MO.

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Robert A. Djali Department of Podiatry, SSM Health DePaul Hospital, St. Louis, MO.

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Malreduction of a distal fibular fracture can lead to degenerative changes in the ankle joint. Previous studies have shown that the selective use of various fibular reconstructive osteotomies may halt the progression of degenerative arthritis by restoring the normal tibiotalar contact area and decreasing the stresses on the articular cartilage. In this case report, we achieved alignment with restoration of the talocrural angle and Shenton's line of the ankle using a transfibular osteotomy and an allogeneic fresh-frozen femoral head graft to fill the resultant defect. The advantage of this procedure is twofold. First, fibular-lengthening procedures may potentially decrease the eventual need for joint-sacrificing procedures such as an arthrodesis or arthroplasty. Second, an allograft allows for larger deficit correction without concern for donor-site morbidity. To our knowledge, this is the first case report using a fresh-frozen femoral head allograft for a fibular-lengthening osteotomy in the podiatric medical literature. Further research with larger patient populations is needed to establish whether fresh-frozen femoral head allograft is a reliable graft option for fibular-lengthening procedures.

Corresponding author: Khawar Malik, DPM, Department of Podiatry, SSM Health DePaul Hospital, 11709 Old Ballas Rd, Suite 201, St. Louis, MO 63141. (E-mail: kmalikdpm@gmail.com)