{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T11:57:48Z","timestamp":1781697468342,"version":"3.54.5"},"reference-count":38,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","journal-cot.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Clinical Orthopaedics and Trauma"],"published-print":{"date-parts":[[2026,7]]},"DOI":"10.1016\/j.jcot.2026.103454","type":"journal-article","created":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T14:44:45Z","timestamp":1777214685000},"page":"103454","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Distal tibial metaphyseal malunion: current concepts"],"prefix":"10.1016","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4083-2912","authenticated-orcid":false,"given":"Megna","family":"Panchbhavi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Lantieri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amiethab","family":"Aiyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"3","key":"10.1016\/j.jcot.2026.103454_bib1","first-page":"129","article-title":"The rates of nonunion and malunion in lower extremity fractures: experience in South Carolina over 17 years","volume":"29","author":"Daley","year":"2020","journal-title":"J Surg Orthop Adv"},{"issue":"12","key":"10.1016\/j.jcot.2026.103454_bib2","doi-asserted-by":"crossref","first-page":"2845","DOI":"10.3390\/ijerph15122845","article-title":"Incidence, costs and predictors of Non-Union, delayed union and mal-union following long bone fracture","volume":"15","author":"Ekegren","year":"2018","journal-title":"Int J Environ Res Publ Health"},{"issue":"2","key":"10.1016\/j.jcot.2026.103454_bib3","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.fas.2023.10.007","article-title":"Numerical simulations of the effect of lateral malleolus fracture malunion on ankle biomechanics: different offset directions and offsets","volume":"30","author":"Gu","year":"2024","journal-title":"Foot Ankle Surg"},{"key":"10.1016\/j.jcot.2026.103454_bib4","series-title":"Rockwood & Green's Fractures in Adults","year":"2006"},{"key":"10.1016\/j.jcot.2026.103454_bib5","series-title":"Principles of Deformity Correction","first-page":"571","article-title":"Ankle and foot considerations","author":"Paley","year":"2002"},{"issue":"10","key":"10.1016\/j.jcot.2026.103454_bib6","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1177\/107110070602701005","article-title":"Malreduction of the tibiofibular syndesmosis in ankle fractures","volume":"27","author":"Gardner","year":"2006","journal-title":"Foot Ankle Int"},{"issue":"6","key":"10.1016\/j.jcot.2026.103454_bib7","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1302\/2058-5241.6.210015","article-title":"Radiological assessment of lower limb alignment","volume":"6","author":"Marques Lu\u00eds","year":"2021","journal-title":"EFORT Open Rev"},{"issue":"3","key":"10.1016\/j.jcot.2026.103454_bib8","doi-asserted-by":"crossref","first-page":"389","DOI":"10.3390\/medicina58030389","article-title":"Malunion of the tibia: a systematic review","volume":"58","author":"Patel","year":"2022","journal-title":"Medicina (Kaunas)"},{"issue":"1","key":"10.1016\/j.jcot.2026.103454_bib9","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.fcl.2015.09.003","article-title":"Corrective osteotomies for malunited malleolar fractures","volume":"21","author":"Weber","year":"2016","journal-title":"Foot Ankle Clin"},{"issue":"Suppl 1","key":"10.1016\/j.jcot.2026.103454_bib10","doi-asserted-by":"crossref","first-page":"S66","DOI":"10.1016\/S0020-1383(18)30307-3","article-title":"Malalignment in plate osteosynthesis","volume":"49","author":"Anneberg","year":"2018","journal-title":"Injury"},{"issue":"1","key":"10.1016\/j.jcot.2026.103454_bib11","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.fcl.2015.09.008","article-title":"Intra-articular osteotomy for correction of malunions and nonunions of the tibial pilon","volume":"21","author":"Rammelt","year":"2016","journal-title":"Foot Ankle Clin"},{"issue":"7","key":"10.1016\/j.jcot.2026.103454_bib12","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1097\/BOT.0b013e31822a526a","article-title":"The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up","volume":"26","author":"Sagi","year":"2012","journal-title":"J Orthop Trauma"},{"issue":"3","key":"10.1016\/j.jcot.2026.103454_bib13","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1097\/00005131-199109000-00001","article-title":"Long-term effects of tibial angular malunion on the knee and ankle joints","volume":"5","author":"Puno","year":"1991","journal-title":"J Orthop Trauma"},{"issue":"2","key":"10.1016\/j.jcot.2026.103454_bib14","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1097\/01.bot.0000199118.61229.70","article-title":"Does fibular plating improve alignment after intramedullary nailing of distal metaphyseal Tibia fractures?","volume":"20","author":"Egol","year":"2006","journal-title":"J Orthop Trauma"},{"issue":"3","key":"10.1016\/j.jcot.2026.103454_bib15","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1177\/1938640018766631","article-title":"Weight-Bearing radiographic analysis of the tibiofibular syndesmosis","volume":"12","author":"Amin","year":"2019","journal-title":"Foot Ankle Spec"},{"issue":"2","key":"10.1016\/j.jcot.2026.103454_bib16","doi-asserted-by":"crossref","first-page":"215","DOI":"10.35366\/101870","article-title":"Medial malleolus malunion with secondary tibiotalar and syndesmotic incongruence - two case reports and \u201c\u2018box resection\u2019\u201d for its treatment","volume":"35","author":"Caetano","year":"2021","journal-title":"Acta Ortop Mex"},{"issue":"2","key":"10.1016\/j.jcot.2026.103454_bib17","doi-asserted-by":"crossref","first-page":"255","DOI":"10.3390\/bioengineering10020255","article-title":"Gait analysis to monitor fracture healing of the lower leg","volume":"10","author":"Warmerdam","year":"2023","journal-title":"Bioengineering (Basel)"},{"issue":"3","key":"10.1016\/j.jcot.2026.103454_bib18","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1302\/0301-620X.77B3.7744927","article-title":"The epidemiology of tibial fractures","volume":"77","author":"Court-Brown","year":"1995","journal-title":"J Bone Jt Surg Br"},{"issue":"5","key":"10.1016\/j.jcot.2026.103454_bib19","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1302\/0301-620X.77B5.7559711","article-title":"Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. Classification and treatment by locked intramedullary nailing","volume":"77-B","author":"Robinson","year":"1995","journal-title":"J Bone Jt Surg Br"},{"issue":"11","key":"10.1016\/j.jcot.2026.103454_bib20","article-title":"Association of fracture location and pattern with nonunion or malunion in Tibia fractures managed with intramedullary nailing: a retrospective study","volume":"15","author":"Alam","year":"2023","journal-title":"Cureus"},{"issue":"6","key":"10.1016\/j.jcot.2026.103454_bib21","doi-asserted-by":"crossref","first-page":"3265","DOI":"10.1007\/s00590-024-04062-x","article-title":"Risk factors for malalignment after intramedullary nail treatment of distal tibia fractures with associated fibula fractures","volume":"34","author":"Chaudhry","year":"2024","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"10","key":"10.1016\/j.jcot.2026.103454_bib22","doi-asserted-by":"crossref","first-page":"3132","DOI":"10.1016\/j.injury.2021.02.040","article-title":"Do Poller screws effect union in tibial shaft fractures treated with intramedullary nailing?","volume":"52","author":"Peat","year":"2021","journal-title":"Injury"},{"issue":"1","key":"10.1016\/j.jcot.2026.103454_bib23","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s13018-023-04472-3","article-title":"Risk factors for malunion of distal tibia fractures treated by intramedullary nailing","volume":"19","author":"Daas","year":"2024","journal-title":"J Orthop Surg Res"},{"issue":"4","key":"10.1016\/j.jcot.2026.103454_bib24","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.cpm.2017.05.003","article-title":"Supramalleolar osteotomies","volume":"34","author":"Chopra","year":"2017","journal-title":"Clin Podiatr Med Surg"},{"issue":"12","key":"10.1016\/j.jcot.2026.103454_bib25","doi-asserted-by":"crossref","DOI":"10.1016\/j.injury.2025.112888","article-title":"Preoperative malnutrition is associated with increased treatment failure and salvage procedures following surgical fixation of ankle and pilon fractures","volume":"56","author":"Pereira","year":"2025","journal-title":"Injury"},{"issue":"1","key":"10.1016\/j.jcot.2026.103454_bib26","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/BOT.0000000000002293","article-title":"Open ankle fractures: what predicts infection? A multicenter Study","volume":"36","author":"Cooke","year":"2022","journal-title":"J Orthop Trauma"},{"issue":"10","key":"10.1016\/j.jcot.2026.103454_bib27","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1097\/00005131-200211000-00002","article-title":"Extraosseous blood supply of the Tibia and the effects of different plating techniques: a human cadaveric study","volume":"16","author":"Borrelli","year":"2002","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.jcot.2026.103454_bib28","first-page":"209","article-title":"Ankle malunion: when and how to perform supramalleolar osteotomy","volume":"73","author":"Mateluna","year":"2024","journal-title":"Instr Course Lect"},{"issue":"8","key":"10.1016\/j.jcot.2026.103454_bib29","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/j.fas.2024.05.009","article-title":"Advancing treatment strategies for posterior malleolar malunion: the ankle dislocation method","volume":"30","author":"Shen","year":"2024","journal-title":"Foot Ankle Surg"},{"issue":"1","key":"10.1016\/j.jcot.2026.103454_bib30","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s00590-023-03660-5","article-title":"Circular external fixation for revision of failed tibia internal fixation","volume":"34","author":"Marwan","year":"2024","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"8","key":"10.1016\/j.jcot.2026.103454_bib31","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1007\/s00590-018-2231-x","article-title":"Functional outcomes of the failed plate fixation in distal tibial fractures salvaged by hexapod external fixator","volume":"28","author":"Molepo","year":"2018","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"1","key":"10.1016\/j.jcot.2026.103454_bib32","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1177\/10711007231201823","article-title":"Osteoperiosteal iliac autograft transplantation for unreconstructable tibial plafond after malunions of pilon fractures in young patients","volume":"45","author":"Gan","year":"2024","journal-title":"Foot Ankle Int"},{"issue":"1","key":"10.1016\/j.jcot.2026.103454_bib33","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s00264-025-06707-w","article-title":"Joint-preserving corrective reconstruction strategy for malunions of tibial pilon fractures in young patients","volume":"50","author":"Gan","year":"2026","journal-title":"Int Orthop"},{"issue":"3","key":"10.1016\/j.jcot.2026.103454_bib34","first-page":"328","article-title":"[Application of bone transport with unilateral external fixator combined with locked plate internal fixation in treatment of infected tibial nonunion]","volume":"33","author":"Chen","year":"2019","journal-title":"Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi"},{"issue":"3","key":"10.1016\/j.jcot.2026.103454_bib35","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.ST.20.00059","article-title":"Treatment of a diaphyseal tibial malunion with use of the clamshell osteotomy","volume":"11","author":"Pires","year":"2021","journal-title":"JBJS Essent Surg Tech"},{"issue":"10","key":"10.1016\/j.jcot.2026.103454_bib36","doi-asserted-by":"crossref","DOI":"10.1097\/BOT.0000000000001257","article-title":"Clamshell osteotomy for acute fractures in the malunion setting: a technical note","volume":"32","author":"Pires","year":"2018","journal-title":"J Orthop Trauma"},{"issue":"3","key":"10.1016\/j.jcot.2026.103454_bib37","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.CC.23.00072","article-title":"Distal tibial metaphyseal malunion treated with clamshell osteotomy: a case report","volume":"13","author":"Darden","year":"2023","journal-title":"JBJS Case Connect"},{"issue":"9","key":"10.1016\/j.jcot.2026.103454_bib38","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1177\/1071100717709566","article-title":"Supramalleolar osteotomy for tibial component malposition in total ankle replacement","volume":"38","author":"Deforth","year":"2017","journal-title":"Foot Ankle Int"}],"container-title":["Journal of Clinical Orthopaedics and Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0976566226001219?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0976566226001219?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T11:35:38Z","timestamp":1781696138000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0976566226001219"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":38,"alternative-id":["S0976566226001219"],"URL":"https:\/\/doi.org\/10.1016\/j.jcot.2026.103454","relation":{},"ISSN":["0976-5662"],"issn-type":[{"value":"0976-5662","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Distal tibial metaphyseal malunion: current concepts","name":"articletitle","label":"Article Title"},{"value":"Journal of Clinical Orthopaedics and Trauma","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jcot.2026.103454","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Delhi Orthopedic Association. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"103454"}}