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Medial malleolar osteotomy

Planning of the osteotomy

The osteotomy must be in such a way that it avoids the distal tibial plafond.

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 cartilage.

The medial malleolus is then cracked and displaced distally for access to the talus.
In that fashion, the articular surface can be re-apposed without articular loss at the end of the operation.