Dr Sandeep Patel, Associate Professor of Orthopaedics at Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, has introduced a novel classification system—named the Patel-Dhillon Classification—for ankle malunions, marking a milestone in trauma and reconstructive orthopaedic surgery.
Ankle malunion occurs when fractures around the ankle heal in improper alignment—often due to delayed treatment or inadequate fixation.
These complex deformities may lead to pain, instability, altered gait mechanics, and early-onset arthritis if left uncorrected.
Traditionally, many such cases were treated with ankle fusion (arthrodesis), permanently eliminating joint motion to relieve pain.
With advances in orthopaedic reconstruction, however, joint-preserving corrective surgeries (such as osteotomies and realignment procedures) are increasingly being performed in select patients.
The Patel-Dhillon Classification provides a structured and comprehensive framework that covers all types of ankle malunions, enabling surgeons to assess the anatomical and mechanical deformity in detail and select optimal corrective strategies.
Dr Patel explained the importance of the work: Ankle malunions have long been considered difficult to manage, with fusion often seen as the only solution.
Through this classification, we aim to provide clarity and direction to surgeons in analysing the deformity comprehensively and choosing corrective, joint-preserving procedures wherever possible.
It represents an important step toward restoring both form and function in patients who otherwise would have lost their ankle joint.”
This classification has now been published in the Indian Journal of Orthopaedics and signifies a significant academic contribution from PGIMER to modern orthopaedic practice.
Furthermore, this is Dr Patel’s third classification related to fractures and injuries around the ankle developed in the past two years.
He also holds the distinction of being the only Indian surgeon in the past year to have a fracture pattern around the ankle named after him.
What this means for patients and surgeons:
- A common language and structure for describing ankle malunions improves consistency in assessment and decision-making.
- A greater focus on joint-preserving options (rather than default fusion) for appropriate cases, offering potential for better functional outcomes.
- Enhanced ability to tailor corrective procedures (osteotomy, realignment, reconstruction) based on the specific type and severity of malunion.
- The possibility of improving long-term joint health, gait mechanics and quality of life for patients who might previously have been resigned to fusion with loss of ankle motion.
As next steps, broader clinical validation across multiple centres and longer-term outcome studies will test how widely the Patel-Dhillon Classification can be adopted and how it performs in guiding treatment and predicting results.
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