54: Gradual Correction of Distal Tibia Malunion (Varus with Shortening)

Fig. 1

Pre-operative full-length standing radiographs revealing isolated distal tibia deformity and mild arthritis of the tibiotalar joint

Fig. 2

Pre-operative lateral radiograph revealing posterior translation of the distal fragment and mild tibiotalar joint arthritis

2 Preoperative Clinical Photos and Radiographs

See Figs. 1, 2, and 3.

Fig. 3

Deformity analysis

3 Preoperative Problem List

Deformity analysis (Fig. 3):

15° varus deformity
10 mm posterior translation of the distal fragment
7 mm shortening compared to contralateral side
5 degrees of external rotation (assessed clinically)
CORA at the level of her healed fracture

Metabolic issues:

Hypothyroidism

4 Treatment Strategy

Given the degree of deformity combined with shortening and rotation, the Taylor Spatial Frame was chosen to gradually correct the deformity. An acute correction could have been performed with internal fixation; however, this would have left the patient almost 1 cm short based on her deformity analysis. A gradual correction, restoring anatomic length, alignment, and rotation, would give her the best possible outcome.