Total ankle replacement with a staged correction of a 20 deg
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Total ankle replacement can be a challenging surgery especially when pre-operative deformity exists. Most authors advocate the indication for total ankle replacement should be narrowed to patients with less than 10 to 15 degrees of preoperative varus or valgus. When greater than 10-15 degrees of coronal plane malalignment is found, ancillary procedures must be performed. We report a case of a 56-year-old male with 20 degrees of pre-operative ankle valgus after a pronation-external rotation injury that was malreduced at an outside institution. In addition to the valgus, the patient presented with medial ankle instability, distal lateral tibial osteonecrosis and a shortened, posteriorly rotated fibula. Staged procedures were employed to successfully realign the patient’s ankle joint. The patient was first brought to the operating room and stressed under c-arm fluoroscopy. He was found to have instability of the deltoid complex. He subsequently underwent an ankle arthrotomy, synevectomy and deltoid imbrication to re-establish medial ankle stability. Second, the patient underwent a fibular lengthening and derotation, syndesmotic fusion and medial opening wedge tibial osteotomy.

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