# Supramalleolar osteotomy outcomes for post-traumatic fracture-related ankle arthritis: a retrospective analysis

## TL;DR

This study shows that supramalleolar osteotomy improves pain and function in patients with ankle arthritis from old fractures.

## Contribution

The study provides early-to-mid-term evidence of supramalleolar osteotomy's effectiveness for post-traumatic ankle arthritis.

## Key findings

- SMO significantly improved AOFAS scores, FFI, and VAS pain scores post-surgery.
- Patient satisfaction was 89.5%, with no significant impact from time since fracture or preoperative talar tilt.
- No significant progression of arthritis stage was observed after SMO.

## Abstract

This study aimed to investigate the early-to-mid-term efficacy of supramalleolar osteotomy (SMO) for the management of post-traumatic ankle arthritis resulting from previous fractures.

A retrospective analysis was conducted on the clinical data of 19 individuals with post-traumatic ankle arthritis secondary to old fractures treated with SMO between March 2018 and September 2022. The cohort included 6 males and 13 females, aged 15 to 59 years, with an average of 37.1 ± 15.8 years. Among these cases, 12 underwent surgical treatment for their initial fractures, while 7 received conservative management. Clinical efficacy was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Foot Function Index (FFI), and Visual Analog Score (VAS) for pain. Imaging analyses were conducted using the changes of tibial anterior surface angle (TAS), talar tilt (TT) angle, and modified Takakura stage. Evaluation of patient satisfaction after surgery was conducted during the final follow-up.

All patients were followed up for 12 to 47 months (mean follow-up: 21.9 ± 11.1 months). At the final follow-up, the AOFAS ankle-hindfoot score improved to 81.9 ± 9.8, the FFI decreased to 24.2 ± 22.8, and the VAS score decreased to 3.2 ± 3.0, all showing significant improvement compared with preoperative values (p < 0.05). The TAS angle increased significantly to 90.2° ± 5.1° postoperatively (p < 0.05), while the TT angle was 0.3° ± 2.5°, without a statistically significant change (p = 0.314). No significant progression was observed in the modified Takakura stage (p = 0.458). The overall patient satisfaction rate was 89.5% (17/19). Prognostic analysis revealed no correlation between fracture-to-surgery interval (1–27 years) and AOFAS improvement ( r = 0.233, p = 0.337). Excessive preoperative TT (> 7.3°) did not compromise outcomes after correction.

SMO demonstrates favorable early-to-mid-term efficacy in the treatment of traumatic fracture-related ankle arthritis, with significant improvements in pain relief, functional scores, and patient satisfaction. Prognostic factors (time since fracture, severe talar tilt) did not adversely affect results, supporting SMO’s utility across diverse presentations.