Medial Gradual Opening Osteotomy of the Tibia With Monolateral External Fixator for Correcting the Varus Deformity of the Tibia

Abstract

Correction of the varus deformities in the tibia is necessary because of the excessive pressure exerted on the medial compartment of the knee, which intensifies the degenerative process. Correction strategies encompass a variety of approaches and depend on the patient's individual characteristics, age, soft tissue condition, and the orthopaedic surgeon's experience with different surgical materials. Size and location of the deformity, whether gradual or acute, play crucial roles in choosing the most appropriate material and shape. The gradual correction is especially indicated for patients with severe deformities, soft tissue involvement, and a history of bone infections. This study aimed to introduce a gradual correction technique for varus deformities in the tibia using a unilateral external fixator and to describe the postoperative follow-up. This technique offers notable advantages, including accurate correction, better patient acceptance, lighter assembly, less risk of pseudarthrosis, and shorter distraction process owing to the use of a single piece. In addition, the operated limb can support the load on the day after surgery, and dynamic follow-up is performed on an outpatient basis.

Fig 1

ProCallus Fixator Orthofix pieces (Orthofix). (A) T clamp. (B) Straight clamp. (C) Self-centering fixator body. (D) Drill guide. (E) T-key. (F) L-key. (G) Distractor device (Orthofix).

Fig 2

Step-by-step guide. (A) Varus deformity. (B) Hinge fastener on center of rotation angulation (location of tibia partial osteotomy). (C) Marking the first pin parallel to the proximal tibia articular surface. (D) First proximal pin with assembly. (E) First distal pin parallel to ankle surface. (F) Second distal pin parallel to first distal pin and ankle articular surface on coronal plane. (G) Second proximal pin parallel to first pin on axial plane and to proximal tibia articular surface on coronal plane. (H) Osteotomies—partial tibia osteotomy and total fibular osteotomy.

Fig 3

Varus gradual correction. (A) Deformity. (B) Immediately postoperative. (C) Six weeks postoperative. (D) Four months postoperative—final correction. (E) Five months postoperative.