Planning of the osteotomy
The osteotomy must be in such a way that it avoids the distal tibial
The articular surface is violated only in the infratectal region.
This is done first by visualizing the joint surface before cutting. The
medial malleolus is predrilled and pretapped. Then an oscillating saw cuts the
bone at 90 degrees to the screw position but does not penetrate the articular
The medial malleolus is then cracked and displaced distally for access to
In that fashion, the articular surface can be re-apposed without articular loss
at the end of the operation.