[Intra-articular osteotomy for malunion of the tibial plateau].

objectiveRestoration of anatomy of the joint surface of the tibial plateau in posttraumatic deformity. INDICATIONS: Malunions of the tibial plateau with significant intra-articular depression and/or steps. CONTRAINDICATIONS: Local or systemic infection, critical soft tissues in the area of planned incisions; advanced osteoarthritis of the knee; loss of meniscus in the involved compartment; motoric or neurophysiological impairment hindering normal knee function. SURGICAL TECHNIQUE: Malunion after posteromedial split fracture: posterior approach in prone position, osteotomy of the former fragment following the fracture lines, anatomical reduction of the fragment in extended position of the knee using the implant as reduction tool, fixation by posterior plate. Malunion after lateral and posterolateral split/depression fracture: Lateral approach with fibula head osteotomy in lateral decubitus position, intra-articular osteotomy of depressed fragments, autologous bone graft, lateral or posterolateral plate osteosynthesis. Osteosynthesis of fibula head with small fragment lag screw or tension-band. POSTOPERATIVE MANAGEMENT: Walking with crutches starting from day 1 after surgery. Partial weight-bearing until radiographic healing of the osteotomies, usually 4-6 weeks. No limitation of range-of-motion.

resultsA series of 23 patients had lateral corrective osteotomy after lateral tibial plateau fracture. Mean follow-up was 13 years (range 2-26 years). Two patients had early poor results. In all, 17 patients (74%) scored excellent in the Lysholm/Gillquist score, 3 patients good, 1 patient average and 2 patients poor.