Severe Varus Knee Deformity After Malunited Proximal Tibial Fracture Treated With Open-Wedge Distal Tuberosity...

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.