Foot and Ankle International - 2026-03-17 - Journal Article
Medial Malleolar Osteotomy: The Influence of 2 Types of Osteotomies and 2 Fixation Methods on Articular Displacement in Fresh-Frozen Cadaveric Specimens.
Costa MT, Bergamasco JMP, De Marchi Neto N, Yonamine ES, Santili C
Topics
Key Takeaway
Chevron medial malleolar osteotomy fixed with 3 screws produced zero measurable articular displacement versus 50% step-off rate with oblique osteotomy and 2-screw fixation in a cadaveric model.
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Summary
This cadaveric study compared oblique versus chevron medial malleolar osteotomies with 2- versus 3-screw fixation across 4 groups of 10 specimens each, measuring articular step-off with a digital caliper after talus removal. Chevron osteotomy produced articular displacement in 21.1% of specimens versus 50% for oblique osteotomy; 3-screw fixation similarly reduced incongruence to 21.1% versus 50% with 2 screws. The chevron-plus-3-screw combination achieved 0% measurable displacement, supporting both study hypotheses.
Key Limitation
Static cadaveric measurement without cyclic loading or weight-bearing simulation cannot confirm whether the observed displacement differences persist under in vivo mechanical conditions.
Original Abstract
BACKGROUND
The medial malleolar osteotomy is required in some cases of osteochondral lesions, bone tumors, and fractures of the medial talar dome for surgical access. The literature is uncertain about which type of osteotomy and fixation is best. The objective of this study was to compare, in cadaveric specimens, the oblique and chevron medial malleolar osteotomies and their fixation with either 2 or 3 screws, evaluating the possibility of articular displacement. We hypothesize that the chevron osteotomy results in a lower chance of articular displacement at the end of the procedure than the oblique osteotomy. Our second hypothesis is that fixation with 3 screws also reduces the risk of articular displacement compared with 2 screws.
METHODS
Forty anatomical fresh‑frozen specimens were analyzed and divided into 4 groups (10 per group): oblique osteotomy fixed with 2 or 3 screws and chevron osteotomy fixed with 2 or 3 screws. One fracture occurred in the chevron osteotomy group with 3 screws, leaving 39 specimens for analysis. After osteotomies and fixation, the talus was removed, and articular displacement (step‑off) of the distal tibia was assessed using a digital caliper.
RESULTS
The results indicated a lower incidence of articular displacement in chevron osteotomy (21.1%) compared with oblique osteotomy (50%). Fixation with 3 screws showed a lower rate of incongruence (21.1%) compared with 2 screws (50%). When the type of osteotomy and fixation were combined the chevron osteotomy fixed with 3 screws had no measurable articular displacement in this cadaveric model.
CONCLUSION
In this cadaveric surgical technique model, a chevron medial malleolar osteotomy fixed with 3 screws showed no measurable articular displacement and overall had a lower risk of articular step‑off compared with oblique osteotomy and 2‑screw fixation.