Fracture of the proximal tibia with immediate weightbearing after a Fulkerson osteotomy

The records of 234 people who had anteromedialization of the tibial tubercle with oblique osteotomy between 1983 and 1994 at two separate institutions were reviewed retrospectively. Six patients (2.6%) had fractures of the proximal tibia postoperatively, within 13 weeks of the Fulkerson osteotomy. All fractures occurred after a change in the postoperative physical therapy regimen from partial weightbearing to immediate full weightbearing. All fractures healed with acceptable alignment of less than 5 degrees of varus-valgus or anteroposterior angulation. Given this increase in fracture incidence, a more conservative postoperative physical therapy regimen is recommended. All patients should be nonweightbearing initially, advanced gradually to partial weightbearing, and allowed full weightbearing only after the osteotomy has radiographic evidence of complete healing.