This retrospective case series by Guo C et al. reported that supramalleolar osteotomy with intra-articular osteotomy had relatively good clinical results in the treatment of malunited medial impacted ankle fractures for maintaining ankle function. This is the right choice for the treatment of malunited medial impacted ankle fractures related to varus deformity. But, the surgeons should be aware of the loss of ankle motion post-operatively in most patients. 

Malunion of a medial impacted ankle fracture may lead to varus ankle deformity. The use of supramalleolar osteotomy plus intra-articular osteotomy in patients with malunited medial impacted ankle fractures was explored in this study.

This retrospective study comprised of 24 patients with malunited medial impacted ankle fracture who were treated between January 2011 and December 2014. Using Weber's classification, 10 had type A fractures and 14 had type B, and with the AO classification, 20 had 44A2, and 4 had 44B3. All of these patients suffered from varus ankle deformity. Supramalleolar osteotomy plus intra-articular osteotomy was performed. Visual analog scale (VAS) for pain during daily activities, Olerud and Molander Scale and the modified Takakura classification stage helped to determine the clinical outcomes, and radiographic analysis was performed.

The radiographic parameters, comprising of the tibial ankle surface (TAS) angle and talar tilt angle (TTA), had significant differences between the preoperative and follow-up assessments. The mean tibial lateral surface (TLS) did not show any significant change. At the latest follow-up, the average Olerud and Molander Scale score improved significantly from 56.4 ± 6.21 preoperatively to 77.0 ± 6.1. At the most recent follow-up, the mean VAS decreased significantly from 6.7 ± 0.8 preoperatively to 3.1 ± 0.6. No significant difference in the modified Takakura classification stage was noticed between the preoperative assessment and the last follow-up.

The use of a supramalleolar osteotomy plus intra-articular osteotomy was an effective choice for the treatment of malunited medial impacted ankle fractures related to varus ankle deformity.