Correction of lateral tibial plateau depression and valgus malunion of the proximal tibia.
OBJECTIVE
Improvement of joint congruency in malunited lateral tibial plateau fractures, reduction of pain, prevention of osteoarthritis.


METHODS
Valgus malalignment of the proximal tibia combined with intraarticular depression of the tibial plateau.


METHODS
Patients in poor general condition. Severe loss of knee function Elderly patients (> 65 years). Chronic infection. Soft-tissue problems, Inability to perform non-weight bearing after the operation


METHODS
Oblique osteotomy of the middle third of the fibula. Straight lateral or parapatellar approach to the lateral proximal tibia. Lateral arthrotomy of the knee joint. Proximal open wedge osteotomy of the tibia. Intraarticular correction of the depressed lateral tibial plateau through subchondral impaction of cancellous bone grafts. Evaluation of leg alignment. Interposition of bicorticocancellous bone grafts to maintain the open wedge osteotomy. Internal fixation, if necessary.


METHODS
Continuous passive motion to 90 degrees of flexion from the 1st postoperative day. After application of a stabilizing brace, patients are allowed toe-touch weight bearing for 8 weeks. After radiologic bony healing has occurred, patients are allowed to increase weight bearing stepwise.


RESULTS
Between 1977 and 1998, 23 patients were operated on. There were two failures resulting in one arthrodesis and one total knee arthroplasty. After an average of 14 years (5-26 years) 21 patients were followed up. Two patients suffered from severe progression of osteoarthritis after the osteotomy, four had some progression of cartilage degeneration, and 15 presented without changes in osteoarthritis. Mean difference in pre- and postoperative tibiofemoral angle was 8.6 degrees (range 13-4.4 degrees), mean difference in pre- and postoperative depression 6 mm (range 4-9 mm), and mean difference in pre- and postoperative range of motion 12 degrees (range 0-20 degrees). There were no nonunions.
Marti
René K
RK
Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. r.k.marti@gmail.com
Kerkhoffs
Gino M M J
GM
Rademakers
Maarten V
MV
D001178:Arthroplasty / Q000295:instrumentation / Q000379:methods; D016025:Bone Transplantation; D006801:Humans; D016916:Joint Deformities, Acquired / Q000601:surgery*; D007719:Knee Joint / Q000002:abnormalities* / Q000601:surgery*; D010027:Osteotomy / Q000295:instrumentation* / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D013977:Tibia / Q000002:abnormalities* / Q000601:surgery*; D016896:Treatment Outcome