Failure to anatomically reduce and stabilize the fractured distal fibula can result in malunion of the fibula and malreduction of the ankle mortise. Fibular malunion results in altered ankle joint biomechanics which often leads to the development of pain, stiffness, and premature joint degeneration. Fortunately, many fibular malunions can be successfully salvaged using osteotomy techniques to restore anatomic fibular length and rotation. Different osteotomy techniques are indicated depending on the location and characteristics of the malunion. In this review, the oblique fibular osteotomy is described for the reconstruction of SER-type fibular fractures. For more proximal fibular malunion, the transverse osteotomy technique with lengthening and structural bone graft is reviewed.

Level V, expert opinion.