title: Corrective tibial osteotomy in young adults using an intramedullary nail.
abstract: OBJECTIVE
  The purpose of this study was to document results of a less invasive technique of open wedge proximal tibial osteotomy (PTO) for the varus knee in young adults using an intramedullary tibial nail.
  
  
  METHODS
  We prospectively studied 24 knees in 16 young patients with varus knee deformity. The mean follow-up was 54 months (range, 36 to 107 months) and the mean age of patients at the time of operation was 25.8 years (range, 18 to 40 years). The open wedge PTO was performed below tibial tuberosity using a percutaneous multiple drill-hole technique. Conventional intramedullary tibial nail was used for fixation without bone graft. Radiographic evaluations were made using mechanical alignment (MA), posterior tibial slope angle, and Insall-Salvati ratio. Union time, loss of correction, implant failure, and associated complications were also investigated.
  
  
  RESULTS
  The mean MA was significantly changed from -9.7° preoperatively to 1.1° at the final follow-up (p<0.001). There was no significant change in the proximal tibial anatomy and patellar height. All patients achieved radiographic bony union at an average of 3.1 months without loss of correction. The only complication was knee pain due to nail prominence in 3 patients.
  
  
  CONCLUSIONS
  Radiographic evaluation indicated that PTO using an intramedullary tibial nail leads to significant improvement in radiographic parameters without changes in posterior tibial slope or patellar height. We found that this technique could be a less invasive and effective alternative for correction of the varus knee in young adults.
authors.affiliation: Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
authors.forename: Kang-Il
authors.initials: KI
authors.lastname: Kim
authors.affiliation: 3D Surgery, Department of Surgery, Clinical Center for University of Munich, Munich, Germany.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Thaller
authors.affiliation: Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
authors.forename: Alankar
authors.initials: A
authors.lastname: Ramteke
authors.affiliation: Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
authors.forename: Sang Hak
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
authors.forename: Seung-Hyuk
authors.initials: SH
authors.lastname: Lee
keywords: Corrective osteotomy; Intramedullary nailing; Knee; Tibia; Varus; Young adult