OSTEOTOMY OF THE EXTERNAL MALLEOLE
INTERESTS
OF OSTEOTOMY OF THE EXTERNAL MALLEOLUS
IN THE SURGICAL TREATMENT OF LESIONS
OUTSIDE THE DOME POSTERO ASTRAGALIAN
IN THE SURGICAL TREATMENT OF LESIONS
OUTSIDE THE DOME POSTERO ASTRAGALIAN
Docteur . Christophe BURES
Clinique Internationale du Parc Monceau
21, Rue de Chazelles - 75017 - Paris
Secretariat: 01 48 88 25 25
The dome astragalian lesions are not uncommon. Our study, non-randomized, open, multicentre, helped collect 36 cases of osteochondral lesions (down by 4 years) astragalian dome, stadiums and various grades, all treated using the technique of mosaic plasty, open exclusive. 6 lesions external lateral and central led to perform a surgical approach of the surgical site by external osteotomy malléolaire
we propose to bring the practical and the various stages of implementation.
we propose to bring the practical and the various stages of implementation.
Because it may be read, in order to individualize the dome of the lesion, often after an anterior lateral arthrotomie would not expose and prepare for future transplant properly.
Because we can easily expose them selves without being deleterious in relation to the soft parts.
Because it is essential to be perpendicular to the receiving site to reconstruct the curvature astragalian and optimize the grafted surface.
Because the only effective solution for accessing the "motor" (astragalian injury), to lift the "hood" (malleolus).
Because, although it is an iatrogenic maneuver, we have not noted morbidity (no late consolidation), and that this technique provides a real comfort to the surgeon, usually seasoned with osteosynthesis of External malléolaires fractures.
The patient is supine, a pillow under the buttocks, allowing a slight rotation of the lower limb, exposing the external malleolus.
The first step is the incision anterolateral external pre malléolaire 5 to 6 cm (Fig .1)
Take care not to damage the nerve musculoskeletal disorders, the main danger of the way first (fig.2 the aplomb of the clip)
The second step is to identify and individualize the tubercle of Chaput on which fits peroneo ligament tibial anterior and inferior (Fig. 3, marking done electric scalpel), and then to realize the osteotome his previous posting (fig. 4) carrying a fragment osteo periosteum sufficient (3 to 4 mm) allows the end a solid fixation by a screw or a ostéosuture and facilitates
The third step is up to the osteotomy oblique ligament above the oscillating saw (fig.5), 1 cm above the ligament. Note that the lock by entering the fragment ostéopériosté detached from the tuber, allowing better exposure osteotomy!
Two spacers, one anterior, the other ostérieur (now using the varus foot inversion and maximum), can fully describe widespread damage, later, by grade IV.
The last step, after treatment grafts ostéocartilagineux, taken from the homo trochlée external side, requires a Osteosynthesis of anatomical malleolus by a plate 1 / 3 tube. Fixing the tuber Chaput, detached, is done with a screw diameter of 3.5 spongy or a ostéosuture (fig.7)
We have carried out six times this type of osteotomy for access to extensive lesions of the posterior external astragalian dome. The vision is total over the lesion.
The latter can be prepared by (curettage, drilling), unimpeded, to the future transplant.
We had no problem building, and have expressed no associated morbidity.
After this surgery ostéocartilagineuse a mobilisaion passive ankle is undertaken in the early postoperative days. Support is banned for six weeks. Osteosynthesis material may be withdrawn after one year.
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