Medial open wedge high tibial osteotomy: an effective procedure for varus malunited neglected proximal tibial plateau fractures: a case series

Abstract

Varus malunited tibial plateau fracture is a disabling condition causing varus thrust gait, instability, and secondary osteoarthrosis. There are few evidence-based guidelines for the management of symptomatic varus malunion in young patients. Our case series aims to review outcomes of open wedge high tibial osteotomy for varus malunited tibial medial plateau fractures. We present case series of three patients who presented with symptomatic varus malunion of proximal tibia with Kellgren-Lawrence stage II or less arthritic changes. All presented with varus thrust. Exclusion criteria for the procedure would be complex intra-articular step malunions and severe arthritic changes. Medial open wedge high tibial osteotomy was performed and stabilized with locking plate and tricortical autograft. Patients were followed up for 12 to 20 months. All achieved deformity correction, reported significant improvement in varus thrust and were satisfied with their improvement in stability and knee function. There was no complication related to wound healing and no delayed loss of correction. The osteotomy led to correction of the coronal deformity and ensured that the collateral balance is restored benefiting the overall gait of the patient. Also, if such a patient undergoes total knee replacement in future, the bone stock will be significantly better with this procedure. Medial open wedge high tibial osteotomy for varus malunited tibial plateau fractures is effective procedure that provides excellent functional and radiologic outcomes, and carries minimal complications.

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