Reachout Orthopedics - Issue 1

was absent. The patient was referred to our hospital. Physical examination showed 45° hyperextension of the left knee, knee flexion loss about 20°, fixed equinus deformity of the left ankle about 50° and 1.5 cm leg length discrepancy (Fig. 1). The radiographic study demonstrated the malunion of the intra- articular of the left proximal tibia (Fig. 2). The electrodiagnostic studies showed complete common peroneal nerve palsy. First, the patient decided to receive the operation to correct the fixed equinus deformity. We performed the lengthening of Achilles tendon and transfer posterior tibial tendon for ankle dorsiflexion. After the surgery, the ankle was immobilization in the neutral position with the short leg cast for 6 weeks. Two months after surgery, the patient still had complained about the sense of unstable of the left knee during walking. Therefore, authors decided to correct the deformity by reducing the tibial slope from 47° anterior incline to 6° posterior incline. Surgical Technique Surgical Approach We approached the proximal tibia with the medial and split anterolateral incision. The patellar tendon was identified and protected, and we performed an anterior open-wedge hepta-lateral osteotomy at the left proximal tibia. Osteotomy and Fixation The osteotomy was begun medially below to the tibial tuberosity and extended upward and posteriorly (Fig. 3). After the osteotomy was performed, the adjustable bone spreader was inserted into the osteotomy site anteriorly. Then, we corrected the alignment gently until the intended alignment could be achieved, and there was no hyperextension of the knee. The tibial shaft was anteriorly translated to decrease the tension of the skin on the spike of the tibial tuberosity and prevent secondary deformity. The reduction was maintained with the adjustable bone spreader. Two iliac strut grafts were placed at the anterior aspect of the osteotomy site. We fixed the proximal tibia with the 3.5-mm LCP® Medial and Lateral Proximal Tibia Plates (Synthes®, West Chester, PA, USA). Rehabilitation Immediately the pain reduced in few days after surgery, the range of motion exercise was encouraged. Weight bearing was avoided for 6 weeks. Bone union achieved in 3 months (Fig. 4). At 1-year follow-up, the patient can walk independently without pain. The range of motion is normal (Fig. 5). Discussion Traumatic genu recurvatum is not the unco- mmon condition in orthopedics practice. The deformity usually occurs when there is malalignment of osseous or ligamentous injuries. Treatment is based on the severity of the deformity and knee structure injuries [7, 9, 19]. In minor deformity, the patient can use the brace to relieve the symptoms [10, 16]. However, the deformity can progress in some patients in advance. If the deformity becomes more severe and produces symptom, surgery may be indicated [12, 19]. In case deformity is related to the abnor- mal alignment of the proximal tibia, proximal tibial osteotomy may be performed to correct the deformity. The excellent overall outcome after performing corrective osteotomy was 83% [19]. There are many types of the pro- cedure, but there is still no standard proce- dure to treat this condition. Some authors performed osteotomy at the tibial tuberos- Fig. 1: Physical examination showed 45° hyperextension of the left knee, knee flexion loss about 20°, fixed equinus deformity of the left ankle about 50°. Fig. 2: The radiographic study demonstrated the malunion of the intra- articular of the left proximal tibia. Fig. 3: Pictures demonstrated the anterior open-wedge hepta-lateral osteotomy at the left proximal tibia. 14 reachOut Orthopedics