الفهرس 
Review of literatureOnly 14 pages are availabe for public view
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Abstract
The annual incidence of ankle fractures (AF) is approximately 122-184/100,000 person years. The two age groups most commonly affected are young active men with high-energy trauma, and older women with low energy trauma
The primary goal of ankle fracture treatment is restoration of ankle stability and alignment
Following an ankle fracture, the fibular fracture deformity is usually shortening and external rotation. This shortening permits lateral shift of the talus with persistent instability and valgus tilt. Fibular malunion results in altered ankle joint biomechanics
Many fibular malunions can be successfully salvaged using grafting and plating techniques to restore anatomic fibular length and rotation
In malunited ankle fractures with a shortened fibula and lateral talar shift, reconstruction of the ankle has been advocated in order to restore function. Lengthening of the fibula is an important step in such cases
The fibula is a lateral strut and contributes to maintaining the alignment of the talus with the mortise. The most frequent malunion of the fibula is a shortening and malrotation, and can lead to a widening of the mortise and talar instability
In case of malunited distal fibular fracture, a restoration of the length, angle, and rotation of the fibula can restore the original biomechanics of the ankle and prevent the development of joint degeneration
The main aim of this study was to investigate the functional outcomes and results of fibular lengthening surgeries of malunited pott’s fracture ankle and to know the complications of surgery.
The main results of the study revealed that:
6 studies were prospective studies, 3 retrospective and 1 case report studies
A total of 175 cases were included, m\f was 108\ 67 and mean age was 37 years
Two studies mentioned the side of lesion as right in 26 cases and left side in 14 cases
Mean follow up period was 32.4 months and mean time from injury to reconstruction was 19.9 months
The common interventions procedures used was Ankle joint re-balancing with fibular lengthening, Fibular Lengthening Osteotomy With Revision Syndesmotic Repair, articular reconstruction with malleolar osteotomies, simple open reduction and internal fixation were performed , supramalleolar tibial osteotomy , fibular osteotomy , and supramalleolar tibial osteotomy combined with fibular osteotomy , transverse fibular osteotomy with internal fixation, lengthening only of the fibula , lengthening with correction of the angulation or rotational deformity , and correction of the angular and/or rotational deformity, A transverse fibular osteotomy was made just above the ankle joint and below the tibiofibular syndesmosis .A tricortical iliac bone graft and a lateral fibular plate were applied, reconstructive open reduction and internal fixation, horizontal osteotomy, Z-osteotomy of the fibula, late lengthening of the fibula
Functional outcome showed excellent result in 33 cases , good result in 58 cases , poor results in 16 cases and fair in 5 cases
Satisfactory (excellent\good) in 73 cases and unsatisfactory (fair\poor) in 12 cases
AOFAS was 54.1 pre which improved to 84.6 post
Normal ankle mortise geometry mentioned in 2 studies in 19 cases , the talocrural angle pre mentioned in 2 studies which increased post treatment , as regard sagittal plane motion pre mentioned in 1 study and improved from 28 to 35 post
Tibial anterior surface angle (°) pre improved from 88.50 ± 4.47 to 90.80 ± 3.49 post and Tibial lateral surface angle (°) pre improved from 78.70 ± 5.39 to 79.80 ± 4.91 post , Tibiotalar tilt angle (°) pre was 1.62 ± 1.66 and improved to 0.83 ± 0.90 post , Malleolar angle (°) pre was 82.30 ± 8.03 changed to 78.70 ± 4.76 post
VAS score mentioned in 1 study and improved from 6.76 ± 1.03 pre to 2.03 ± 1.21 post
Complications founded in 14 cases in form of Progression of arthritic changes in 2 cases , persistent pain in 6 cases , infection in 4 cases and tender scar in 2 cases
6 studies examine excellent outcome among cases shows that the event rate was 31.996 % with insignificant differences between studies p value 0.2564
6 studies examine good outcome among cases shows that the event rate was 52.203% with insignificant differences between studies p value 0.1764
6 studies examine poor outcome among cases shows that the event rate was 16.029% with insignificant differences between studies p value 0.9854
4 studies examine fair outcome among cases shows that the event rate was 4.779% with significant differences between studies p value 0.0268
6 studies examine satisfactory (excellent\good) outcome among cases shows that the event rate was 85.795% with insignificant differences between studies p value 0.2757
2 studies examine unsatisfactory (fair\poor) outcome among cases shows that the event rate was 19.004% with insignificant differences between studies p value 0.1829
4 studies examine AOFAS pre and post among cases shows significant increase post treatment than pre-treatment score p value 0.0002
2 studies examine Progression of arthritic changes among cases shows that the event rate was 5.487% with insignificant differences between studies p value 0.5820
2 studies examine persistent pain among cases shows that the event rate was 10.53% with significant differences between studies p value 0.0253
3 studies examine infection among cases shows that the event rate was 8.763% with insignificant differences between studies p value 0.6854
4 studies examine The talocrural angle pre and post among cases shows significant increase post-treatment than pre-treatment score p value <0.0001
Conclusion
Articular reconstruction with malleolar osteotomies is indicated for ankle post-traumatic malalignment. This kind of treatment offers significant reduction of pain, improvement of the joint function and delays the development of post-traumatic arthritis.
Correction must be performed once diagnosed, and there is no maximum elapsed time subsequent to which treatment efficacy is reduced. Even if anatomical reduction cannot be achieved, the improved alignment can produce a satisfactory result.
More clinical studies with larger sample size and longer follow-up are needed to optimize the treatment modality and to assess the risk factors associated with adverse outcome.
Recommendations
Further studies with a larger sample size are needed to confirm the current results.
Further multicenter studies are needed to confirm the current results.
Correction must be performed once diagnosed, and there is no maximum elapsed time after which treatment efficacy is reduced.
Even if anatomical reduction cannot be achieved, the improved alignment can produce a satisfactory result.
Articular reconstruction with malleolar osteotomies offers significant reduction of pain, improvement of the joint function and delays the development of post-traumatic arthritis.
The use of athrodiastasis of the ankle as a secondary procedure may be of value to improve the outcome.
We recommend the combination of Fibular Lengthening Surgeries and other diagnostic methods for better accuracy.