# Severe Varus Knee Deformity After Malunited Proximal Tibial Fracture Treated With Open-Wedge Distal Tuberosity Osteotomy: A Case Report

## TL;DR

A 54-year-old man with a severe varus knee deformity from a childhood fracture was successfully treated with a specialized surgical procedure that corrected alignment and improved function.

## Contribution

This case report demonstrates the effectiveness of open-wedge distal tuberosity osteotomy for severe post-traumatic knee deformities.

## Key findings

- OWDTO achieved a 20° correction, improving alignment and reducing limb length discrepancy.
- The procedure preserved patellar height and allowed full functional recovery within 12 months.
- Combining autologous bone grafting and double plating ensured stable fixation and successful bone healing.

## Abstract

Varus knee deformity following proximal tibial fracture malunion is uncommon and poses surgical challenges due to altered anatomy and large correction requirements. We report the case of a 54-year-old man with progressive right knee pain and severe varus deformity secondary to a proximal tibial fracture sustained in childhood. Radiographs revealed a femorotibial angle (FTA) of 188° and a medial proximal tibial angle (MPTA) of 68°. Preoperative standing full-length radiographs demonstrated a leg length discrepancy (LLD), with a spina-malleolar distance (SMD) of 84.3 cm on the affected side and 87.5 cm on the contralateral side.

Open-wedge distal tuberosity tibial osteotomy (OWDTO) with a 20° correction was performed. The osteotomy gap was filled with autologous iliac bone and β-tricalcium phosphate, and stable fixation was achieved with double plating. A concomitant medial meniscus posterior root tear was repaired arthroscopically. Postoperative alignment improved, with a weight-bearing line ratio (%WBL) of 59% and an MPTA of 88°, and bone union was achieved without complications. Postoperatively, the radiographic SMD improved to 86.5 cm, reducing the limb length discrepancy to approximately 1 cm.

The Caton-Deschamps index remained unchanged postoperatively, indicating that patellar height was preserved. At 12 months, the patient was pain-free and had returned to work. This case highlights the advantages of OWDTO in achieving large angular correction while minimizing the risk of patella baja and improving limb length symmetry. Additionally, the combination of autologous bone grafting and double plating provided sufficient stability and promoted favorable bone healing. OWDTO with autologous bone grafting and double plating is a valuable surgical option for severe post-traumatic varus knee deformities, allowing reliable correction, preservation of patellar height, improvement of LLD, and functional recovery.