Avoiding intraoperative complications in open-wedge high tibial valgus osteotomy: technical advancement

Open-wedge high tibial osteotomy for varus osteoarthritis of the knee is a successful treatment option, but is associated with potential intraoperative complications, jeopardizing outcome. We describe four technical hints avoiding complications as tibia plateau fracture, lateral hinge dislocation, over- and undercorrection, and unwanted increase of the posterior tibial slope and axial malrotation. The technique, which is primarily based on placing five Kirschner-wires (one for the osteotomy direction, two for the external fixator, and two for rotational and slope control) is simple, reproducible, inexpensive, and readily available.