The document outlines a surgical procedure for treating malunion of the distal tibia, detailing steps that include applying an external fixator, performing an open reduction, and using fibular osteotomy. Key steps involve exposing the tibia, mobilizing and lengthening the fracture, and ensuring anatomic reduction during the insertion of a rod. The procedure emphasizes the importance of maintaining stability and avoiding proximal locking if possible.

1. Distal Tibia Malunion
Duane Anderson, MD
September 2023

2. Use of an external fixator, open reduction,
fibular osteotomy and rodding

3. steps
• Apply an external fixator and attach 2 femoral distractors
• Anterolateral incision over the anterior compartment
• Expose the tibia facture and the fibula after doing a generous
fasciotomy, 1 cm fibulectomy
• Mobilize the fracture
• Lengthen the fracture
• Reduce the fracture as anatomically as possible

4. steps
• Ream the proximal fragment, don’t ream the distal fragment
• Place the rod down to the fracture
• VERY slowly advance the nail while maintain anatomic reduction
• Take off the fixator and allow compression of the fx
• Lock distally
• Check for rotational stability
• Don’t lock proximally if you can avoid it
• Use your fibula to bone graft the tibia

5. Femoral distractor, ex fix

6. Incision, fasciotomy, debride and mobilize fx

7. Expose and resect fibula at level of the tibia fx

8. Ream the proximal fragment and insert the rod to
the fx site, advance the nail while keeping reduced

9. interlock distally

10. Proximal interlock?

11. 6 months later