Outcome analysis of modified lateral malleolar osteotomy for the management of talar body fractures associated with tibial pilon fractures.

OBJECTIVE

This study aims to evaluate the clinical efficacy of treating talar body and tibial pilon fractures using a modified lateral malleolar osteotomy approach, with a focus on its advantages.

METHODS

Five patients who underwent a modified lateral malleolar osteotomy for talar body and tibial pilon fractures between July 2021 and June 2024 were included. According to the Sneppen classification, there were three cases of type I and two cases of type II talar body fractures. Pilon fractures were classified as type II using the Rüedi-Allgöwer system, including two cases of AO/OTA type B2 and three cases of type B3. Three fracture cases involved the right foot and two involved the left foot. Clinical outcomes were assessed by measuring the time to a positive Hawkins sign, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the visual analog scale (VAS) pain score, and the active plantar flexion and dorsiflexion range of motion (ROM) of the affected and healthy ankles at the final follow-up.

RESULTS

Intraoperatively, the anterior talofibular ligament (ATFL) was ruptured in three cases and avulsed from the lateral malleolus in one case; only one patient had an intact ATFL. Slight darkening of the incision edge occurred in one patient; however, all incisions healed primarily. All patients were followed up for 18-40 months (mean 26.6 months). Radiographs taken three months postoperatively demonstrated union at the osteotomy site in all cases. All talar fractures healed, with a mean time to positive Hawkins sign of 13.2 ± 1.8 weeks. At the final follow-up, the mean AOFAS score was (77.8 ± 10.0) points, rated as excellent in one case, good in two, and fair in two. The mean VAS score was 1.8 ± 0.8 points. Posttraumatic arthritis developed in one patient, who tolerated the associated pain. The ankle ROM of the affected side remained lower than that of the healthy side at the final follow-up.

CONCLUSION

The modified lateral malleolar osteotomy approach for talar body and tibial pilon fractures is technically straightforward. It provides excellent exposure to the tibiotalar joint surface and fracture fragments, facilitates reliable fixation, and yields acceptable short-term outcomes that may represent a reasonable salvage result given the severity of these injuries.