Reachout Orthopedics - Issue 1

when the location of the osteotomy is proximal to the insertion of patellar tendon. Therefore, the tibial tuberosity transfer is necessary to correct patellar height in this group [12]. In case osteotomy is performed distal to the tibial tuberosity, frequent problems may occur such as secondary deformity and a small correction. Hence, the osteotomy is distal and far from the center of rotation angulation [8, 15]. Recently, a study reported good to excellent result after performing the simple open-wedge osteotomy in which the osteotomy was distal tuberosity. But, authors still needed to transfer the tibial tuberosity in patient with severe deformity (Table 1) [11]. Patients with genu recurvatum and valgus malalignment may be treated by anterolateral open-wedge proximal tibial osteotomy and fixation with a plate with allograft filling of the osteotomy gap [6, 7]. We reported a new technique in which the osteotomy was performed distal to tibial tuberosity aiming to preserve the insertion of the patellar tendon. Then, the direction of the osteotomy was upward and backward which could reach to the center of rotation angulation. The advantages of this technique were high degrees of correction, and patella height could be retained as the preoperative height, but the bone cut was quite tricky from others. This patient showed good result with this technique. However, the higher quality of study design should be performed to evaluate this technique in the future. Conclusion For the patient with severe traumatic genu recurvatum and the preoperative patellar height is still in the normal range, our surgical technique shows the good result after surgical correction. The bone cut can preserve patellar height and provide the high degree of correction. Compliance with ethical standards Conflict of interest: The authors declare that they have no conflict of interest. Ethical approval: Khon Kaen University Ethic Committee in Human Research, Khon Kaen University. References available on request Healthcare.India@springer.com Source: Artit Boonrod, Kamolsak Sukhonthamarn, Punyawat Apiwatanakul. Anterior open‑wedge hepta‑lateral osteotomy for severe post‑traumatic genu recurvatum: a case report and review of the literature. Eur J Orthop Surg Traumatol. 2019;29(2):487–491. DOI 10.1007/s00590-018-2300-1. © Springer-Verlag France SAS, part of Springer Nature 2018. Table 1: Advantages and disadvantages of each anterior open-wedge technique for genu recurvatum. Location of osteotomy Advantages Disadvantages Proximal to tibial tuberosity Near to the center of rotation angulation Higher degree of correction Lesser secondary deformity Patellar baja Need tibial tuberosity transfer in some cases Distal to tibial tuberosity Simple bone cut Simple surgical approach More secondary deformity Lesser degree of correction Anterior skin complication Prominent spike from the tibial tuberosity Need fibular osteotomy in some cases Fig. 4: The radiographic study showed the alignment of proximal tibia after performing surgical correction. Fig. 5: At 1-year follow-up, the patient can walk independently without pain. The range of motion is normal. ity and reflex upward. Then, the author per- formed the anterior open-wedge osteotomy at the level of the patellar tendon insertion [18]. An open-wedge osteotomy was pro- posed in which the osteotomy was performed above the tibial tuberosity. The author called this technique subarticular osteotomy [2]. Closed-wedge osteotomy was performed in some cases in which this technique could provide rapid union [3]. There were many methods to fix or maintain the correction until the union could achieve such as cast, plate and screws, external fixator and Ilizarov apparatus [4–6, 14, 18]. Treatments can be classified according to open- or closed-wedge osteotomy, the location of the osteotomy and acute or gradual correction [2–19]. The open-wedge osteotomy is more sim- plified than closed-wedge osteotomy because it is easy to adjust the correction during oper- ation and can correct leg length. But, there are many considerations on this technique such as location of the osteotomy, secondary de- formity, inadequate correction, anterior bone gap, nonunion, fixation method, infection and skin complication [17, 20]. Patellar baja is themost frequent problem after performing open-wedge osteotomy 15