55: Supramalleolar Dome Osteotomy for Malunion of the Tibia

Fig. 1

Entire leg AP

Fig. 2

Ankle AP X-ray

Fig. 3

Lateral ankle X-ray

Fig. 4

Saltzman showing a valgus deformity on the left side

3 Preoperative Problem List

Distal tibia/ankle valgus deformity
Extensive leg scar tissue
Shortened fibula (absence of middle third)

4 Treatment Strategy

SMO (dome osteotomy) to correct valgus deformity of distal tibia
Internal fixation (crossing screws)
External fixation augmentation in case of insufficient stability of the internal fixation

5 Basic Principles

To perform a dome osteotomy, the center of the dome has to be located at the apex of the deformity. In case the deformity is intrarticular, locate the apex of the dome in the subchondral plate.

A fibula osteotomy has to be performed to allow for adequate rotation of the bone segment.