Easley_CH066.indd

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Operative Techniques in Foot and Ankle Surgery

T E C H N I Q U E S

TECH FIG 10 ● Pre- and postoperative radiographs (weight-bearing anteroposterior, lateral, and Saltzman views, respectively) of a 58-year-old male patient with valgus os- teoarthritis of his ankle joint. The postoperative images are made 1 year after a medial closing wedge osteotomy.

■ Dome-Shaped Osteotomy ■ An anterior approach is used. ■ The level of the osteotomy usually lies at the metaphyseal level, above the tibiofibular syndesmosis. ■ A marking pen can be used to mark the osteotomy of the tibia and the planned angular correction.

■ Multiple 2-mm drill holes along the osteotomy line are made ( TECH FIG 11A ). The osteotomy is then completed with a 5-mm chisel ( TECH FIG 11B ). ■ Prior to mobilization of the osteotomy, the original position of the distal fragment in relation to the proximal fragment is marked on the anterior surface of the tibia (use a marking pen or the electrocautery to mark the bone) ( TECH FIG 11C ).

A

B TECH FIG 11 ● A. Intraoperative image showing the marking of the center of rotation (K-wire) and the drill holes along the osteotomy line. B. Image after completion of the osteotomy with a chisel. (continued)