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Operative Techniques in Foot and Ankle Surgery

POSTOPERATIVE CARE

■ Intraoperative complications include nerve or tendon injury. We ensure that all adjacent neurovascular structures and tendons are identified and protected. SUGGESTED READINGS 1. Knupp M, Pagenstert G, Valderrabano V, et al. Osteotomies in varus malalignment of the ankle [in German]. Oper Orthop Traumatol 2008;20:262–273. 2. Knupp M, Stufkens SA, Bolliger L, et al. Classification and treat- ment of supramalleolar deformities. Foot Ankle Int 2011;32: 1023–1031. 3. Knupp M, Stufkens SA, Pagenstert GI, et al. Supramalleolar osteot- omy for tibiotalar varus malalignment. Tech Foot Ankle Surg 2009;8: 17–23. 4. Knupp M, Stufkens SA, van Bergen CJ, et al. Effect of supramalleolar varus and valgus deformities on the tibiotalar joint: a cadaveric study. Foot Ankle Int 2011;32(6):609–615. 5. Myerson MS, Zide JR. Management of varus ankle osteoarthri- tis with joint-preserving osteotomy. Foot Ankle Clin 2013;18(3): 471–480. 6. Pagenstert GI, Hintermann B, Barg A, et al. Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis. Clin Orthop Relat Res 2007;462:156–168. 7. Pagenstert GI, Knupp M, Valderrabano V, et al. Realignment surgery for valgus ankle osteoarthritis. Oper Orthop Traumatol 2009;21: 77–87. 8. Stamatis ED, Cooper PS, Myerson MS. Supramalleolar osteotomy for the treatment of distal tibial angular deformities and arthritis of the ankle joint. Foot Ankle Int 2003;24:754–764. 9. Stufkens SA, van Bergen CJ, Blankevoort L, et al. The role of the fib- ula in varus and valgus deformity of the tibia: a biomechanical study. J Bone Joint Surg Br 2011;93(9):1232–1239. 10. Takakura Y, Takaoka T, Tanaka Y, et al. Results of opening-wedge osteotomy for the treatment of a post-traumatic varus deformity of the ankle. J Bone Joint Surg Am 1998;80(2):213–218.

■ The leg is elevated in the immediate postoperative period. ■ A compressive dressing and splint are maintained for 2 days to diminish swelling. ■ A short-leg non–weight-bearing cast is used for 6 to 8 weeks. ■ If radiologic evidence of consolidation is present after 6 weeks, partial weight bearing is allowed for 2 weeks, after which the patient advances gradually to full weight bearing. ■ A rehabilitation program for strengthening, gait training, and range of motion is prescribed 8 weeks after surgery, with gradual return to full activities as tolerated. ■ We have been observing our first series of 94 patients with a varus or valgus deformity of the ankle joint for 43 months (range of 12 to 126 months). ■ At the radiographic assessment after 12 months, all oste- otomies showed complete consolidation. Pain reduction was found in all patients, which is similar to earlier reports. Improved radiographic osteoarthritis scores were noted in 75% of the patients. Additionally, patients exhibited a trend toward normalization of gait and function. ■ Apart from perioperative complications such as delayed wound healing problems or infection, postoperative con- cerns include delayed union or nonunion of the osteotomy. ■ Another potential complication is malunion, resulting from inaccurate alignment of the osteotomy at the time of surgery or postoperative loss of position.

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COMPLICATIONS