gms | German Medical Science

54. Jahrestagung der Norddeutschen Orthopädenvereinigung e. V.

Norddeutsche Orthopädenvereinigung

16.06. bis 18.06.2005, Hamburg

Instability of the upper ankle joint following total ankle replacment solved with a plastic castaing procedure

Meeting Abstract

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  • corresponding author U. Böhling - HELIOS Klinikum Emil von Behring Stiftung Oskar Helene Heim, Klinik für Orthopädie, Berlin
  • H. Schamberger - Berlin
  • J. Scholz - Berlin

Norddeutsche Orthopädenvereinigung. 54. Jahrestagung der Norddeutschen Orthopädenvereinigung e.V.. Hamburg, 16.-18.06.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05novEP46

The electronic version of this article is the complete one and can be found online at:

Published: June 13, 2005

© 2005 Böhling et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




The posttraumatic osteoarthritis of the upper ankle joint is increasingly treated by a total joint replacement. The patient we are reporting about presented an additional complex injury of the fibulotalar ligaments. In primary surgery by total ankle replacement this was not solved sufficiently. Consecutively a fibulotalar instability with subluxation of the mobile polyaethylen inlay was the result.

As a salvage procedure during revision a plastic reconstruction by the Castaing procedure has been carried out. The clinical result six months post-operatively shows a very good mobility with fibulotalar stability. Total joint replacement of the upper ankle joint with a comminuted fibulotar ligament complex is possible but plastic reconstruction shoul be obtained initally.


Does outdated tearing of fibulotalar structures accompanied with injury of the tibiofibular syndesmoses represent a contraindication for the total ankle replacement of the upper ankle joint?

Methodology: Primary surgery took place using an uncemented implant via a ventral

Approach. The implant has a mobile polyaethylen. Secondary plastic revision surgery took place one week later.


Six months post operatively the patient was examined clinically and radiologically. Clinically outcome was evaluated with the the Koefoed Score. point Praeoperativ 27 points were rising to post-operatively 93 points. Tibiotalare opening angle was 8° and the anterior talus tilt was 5mm examined in the Scheuba -device.