Restoration of Limb Alignment in Post-Traumatic Genu Varum Case Using Medial Open Wedge Proximal Tibial Osteotomy with Posterior Tibial Slope Correction: A Case Report.

INTRODUCTION: Malunion of proximal tibial fractures may lead to angular deformity, altered limb alignment, and abnormal knee biomechanics. Varus malalignment increases medial compartment loading and predisposes the knee to progressive pain, instability, and early osteoarthritis. In addition, changes in posterior tibial slope can significantly influence knee kinematics and cruciate ligament biomechanics. Corrective osteotomy remains the standard surgical treatment for symptomatic deformities. Medial open-wedge high tibial osteotomy allows controlled correction of coronal plane deformity while preserving bone stock and enabling simultaneous adjustment of posterior tibial slope. We present a case of post-traumatic genu varum with increased posterior tibial slope successfully managed with medial open-wedge proximal tibial osteotomy.

CASE REPORT: A 39-year-old male presented with persistent pain, instability, and deformity of the left knee 10 months after sustaining a proximal tibial fracture that had been treated conservatively. Clinical examination demonstrated approximately 9° varus deformity. Radiological evaluation, including scanogram and computed tomography, revealed proximal tibial malunion with genu varum, decreased medial proximal tibial angle (78.1°), and increased posterior tibial slope of 14°, along with medial deviation of the mechanical axis and early degenerative changes.The patient underwent medial open-wedge proximal tibial osteotomy under fluoroscopic guidance. Controlled opening of the osteotomy allowed simultaneous correction of coronal plane varus deformity and restoration of posterior tibial slope. The osteotomy gap was filled with ipsilateral iliac crest cancellous bone graft and stabilized using a proximal tibial osteotomy plate. Postoperatively, early mobilization and gradual weight-bearing were initiated. Radiographs confirmed restoration of mechanical alignment and correction of posterior tibial slope to approximately 6°. Functional outcome improved significantly, with the Lysholm knee score improving from 52 preoperatively to 94 at 1-year follow-up, indicating excellent functional recovery.

CONCLUSION: Medial open-wedge proximal tibial osteotomy is an effective technique for correcting post-traumatic genu varum with associated posterior tibial slope abnormalities. Simultaneous correction of coronal and sagittal plane deformities restores knee biomechanics, improves functional outcomes, and may prevent progression of degenerative joint changes.