Figure 4

Schematic drawing of anterior distal tibial plafond-plasty. (a) Impaction of the anterior distal tibial plafond was noticed after the talus was reduced back to its normal position. (b) An anterior distal tibial osteotomy was performed along line A, from the superior anterior distal tibia to the apex of the impacted area. (c) A second osteotomy (line B) was performed just above the subchondral bone of the impacted articular surface. The articular surface step-off was reduced. (d) The distal tibial fragment was slid distally until a congruent ankle joint was achieved.