Corrección de genu valgo postraumático con osteotomía de cierre en tibia proximal / High tibial osteotomy for posttraumatic genu valgus deformity correction

OBJETIVO: Presentar un caso de complicación de fractura de platillos tibiales Schatzker VI y su manejo quirúrgico. MATERIAL Y MÉTODO: Se presenta un caso de fractura de platillos tibial Schatzker VI que evoluciona con malalineamiento en valgo secundario a hundimiento del platillo tibial, junto a una revisión de la literatura y la descripción del manejo quirúrgico. RESULTADOS: Se realizó una osteotomía en cuña de cierre medial de tibia proximal y se estabilizó con placa bloqueada (TomoFix), con una corrección completa de la deformidad sin complicaciones. Discusión: La osteotomía en cuña de cierre medial en tibia proximal es una técnica descrita en el manejo de artrosis secundaria a malalineamiento en valgo de la rodilla. Mediante dos osteotomías iniciadas por la cortical medial hacia la lateral con un fulcro esa última, se retira una cuña de dimensiones conocidas y se mantiene la reducción con algún elemento de osteosíntesis. De esa forma, se permite la corrección angular de la deformidad, previamente planificada. Los resultados en distintas series son en general favorables. CONCLUSIÓN: El malalineamiento de la extremidad posterior a una fractura de platillos tibiales y la consecuente sobrecarga del compartimento afectado en la rodilla, asociado al daño articular, evoluciona con degeneración articular que termina en una artrosis unicompartimental secundaria, la cual puede ser prevenida con el uso de osteotomías correctoras de ejes como la osteotomía de tibia proximal, permitiendo normalizar la distribución de las cargas en los compartimentos mediante la corrección del eje mecánico alterado y así prolongar la sobrevida articular.

OBJECTIVE: To present a Schatzker VI tibial plateau fracture case complication and its surgical management METHODS: We present a case of tibial plateau fracture, type VI according to Schatzkeŕs classification, that developed limb malalignment secondary to tibial plateau depression resulting in a genu valgum deformity, along with a literature review and a brief description of the surgical technique. Results: High tibial medial closing wedge osteotomy, stabilized with locking plate (tomoFix) was performed, with a complete correction of the deformity without complications. DISCUSSION: High tibial medial closing wedge is a known procedure used in the management of valgus knee malalignment secondary osteoarthritis. By means of two osteotomies made from medial to lateral cortices, using the latter as a fulcrum, a wedge with known dimensions is subtracted and reduction is maintained with some osteosynthesis element. In this fashion, it allows the previously planned angular correction. Results in different reports are mostly favorable. CONCLUSION: The malalignment of the limb after a tibial plateau fracture and the consequent overload of the affected knee compartment; associated with joint damage, evolves in joint degeneration and eventually, in a secondary unicompartmental osteoarthritis. This can be avoided with the use of corrective osteotomies such as the proximal tibial osteotomy, which allows a proper distribution of loads in the compartments by correcting the altered mechanical axis and thus, prolonging joint survival.

Single time angular deformity correction and treatment of knee instability in congenital fibular hemimelia. A case report.

BACKGROUND: Fibular hemimelia is the most frequently occurring congenital anomaly of long bones. These patients, among other deficiencies, have a poor development of the anterior cruciate ligament (ACL). Unless it causes clinically assessed instability of the knee, nonsurgical treatment is given. When surgical treatment is required, correction of angular limb deformity must be realized prior to ACL reconstruction. METHODS: We present the case of a 16-year old patient with congenital fibular hemimelia. Physical examination showed genu valgum, anteromedial rotatory instability and recurvatum of the right knee. We decided to perform surgical correction of the angular deformities and ACL reconstruction in the same surgical time. RESULTS: Twelve months after surgery, the patient had no evidence of clinical instability, with a range of motion from -5°-110° of the right knee. No claudication or gait instability was found. The KT-1000 arthrometer showed a difference of 2mm between both knees. CONCLUSION: The ACL reconstruction and corrective osteotomies of angular deformities performed in a single surgical procedure had a good clinical result in a 12 month follow up-period, restoring stability of the knee and allowing a normal gait cycle.