Surgical Procedure
Create a curved incision over the medial malleolus
Dissect towards the distal tibial
Dissect towards the anteromedial ankle joint
With the periosteal elevator, slide over the periostium in lateral direction
Place a Hohman retractor at the level just proximal of the joint line
Identify the posterior tibial tendon and incise the tendon sheet.
Use the periosteal elevator for blunt dissection between the posteromedial tendon and the level of the posterior ankle joint and place a Hohman retractor
With use of an arthroscopic probe, identify the posterior and anterior corner of the tibia and mark the saw plane.
Predrill 2 screwholes for later fixation of the osteotomy
Create the osteotomy. Be aware of the talar cartilage. Note the probe in place to identify the appropriate direction of the osteotomy.
Temporarily fixate the distal part of the medial malleolus to the talus with use of a K-wire. In this way the medial malleolus is kept �out of the way�thus providing an excellent exposure of the joint.
In this case, a Hemicap was inserted. To fixate the medial malleolus, reduce the medial malleolus by using 2 K-wires as a guide.
Use a clamp for initial compression of the osteotomy.
Fixate the medial malleolus with 2 lagscrews 3.5mm.
Subcutaneous stitches
Close the skin
Pearls & Pitfalls
Identify the intersection of the horizontal distal tibia and the vertical medial malleolus by means of a arthroscopic probe anterior and posterior.
Make the initial osteotomy by means of an oscillating saw. Don't finish it into the joint in order to avoid cartilage damage to the talus. Finish with an osteotome.