Abstract：
OBJECTIVE: To report a case series of extra-articular osteotomies for the management of intra-articular tibial plateau malunions and to assess the ability to correct deformity and improve knee range of motion (ROM).
METHODS: .
METHODS: Retrospective case series.
METHODS: Academic, tertiary, referral center.
UNASSIGNED: Adult patients with tibial plateau fracture malunion treated with extra-articular osteotomy of the femur and/or tibia between 2014 and 2023.
UNASSIGNED: Mechanical axis deviation (MAD), medial proximal tibia angle (MPTA), lateral distal femoral angle (LDFA), and posterior proximal tibia angle (PPTA) correction; knee ROM; and time to weight bearing.
RESULTS: There were 7 patients included, 6 (85.7%) were female and 1 (14.3%) were male. The median age was 43.5 years (IQR 38.5-51, range 32-62). Four (57.1%) patients were treated with a high tibial osteotomy (HTO), and 3 (42.9%) patients were treated with an HTO and distal femoral osteotomy. One patient had concomitant supramalleolar osteotomy with HTO to address distal tibia procurvatum and valgus. Four were treated with hexapod frames, and 3 were treated with plates and screws. Median follow-up was 22.5 months (IQR 10.5-107 months, range 7-148 months). Surgical intervention corrected median radiographic measures of valgus malalignment preoperatively relative to postoperative values. This included MAD (42.5 mm-0 mm), valgus angle (12.5 degrees-1.5 degrees), MPTA (95 degrees-88.0°), and LDFA (86.0°-87.3 degrees). Surgical intervention increased maximal knee range of motion preoperatively to postoperatively. Median time to full weight bearing was 81.5 days (IQR 46-57 days, range 41-184 days). Two patients were converted to total knee arthroplasty after 5 and 10 years following HTO with hexapod frame.
CONCLUSIONS: Extra-articular osteotomy is an effective treatment for addressing intra-articular malunion after tibia plateau fractures. It is effective in correcting the MAD, valgus deformity, MPTA, LDFA, PPTA, and improving knee ROM (measured through knee extension and flexion).
METHODS: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
METHODS: .
METHODS: Retrospective case series.
METHODS: Academic, tertiary, referral center.
UNASSIGNED: Adult patients with tibial plateau fracture malunion treated with extra-articular osteotomy of the femur and/or tibia between 2014 and 2023.
UNASSIGNED: Mechanical axis deviation (MAD), medial proximal tibia angle (MPTA), lateral distal femoral angle (LDFA), and posterior proximal tibia angle (PPTA) correction; knee ROM; and time to weight bearing.
RESULTS: There were 7 patients included, 6 (85.7%) were female and 1 (14.3%) were male. The median age was 43.5 years (IQR 38.5-51, range 32-62). Four (57.1%) patients were treated with a high tibial osteotomy (HTO), and 3 (42.9%) patients were treated with an HTO and distal femoral osteotomy. One patient had concomitant supramalleolar osteotomy with HTO to address distal tibia procurvatum and valgus. Four were treated with hexapod frames, and 3 were treated with plates and screws. Median follow-up was 22.5 months (IQR 10.5-107 months, range 7-148 months). Surgical intervention corrected median radiographic measures of valgus malalignment preoperatively relative to postoperative values. This included MAD (42.5 mm-0 mm), valgus angle (12.5 degrees-1.5 degrees), MPTA (95 degrees-88.0°), and LDFA (86.0°-87.3 degrees). Surgical intervention increased maximal knee range of motion preoperatively to postoperatively. Median time to full weight bearing was 81.5 days (IQR 46-57 days, range 41-184 days). Two patients were converted to total knee arthroplasty after 5 and 10 years following HTO with hexapod frame.
CONCLUSIONS: Extra-articular osteotomy is an effective treatment for addressing intra-articular malunion after tibia plateau fractures. It is effective in correcting the MAD, valgus deformity, MPTA, LDFA, PPTA, and improving knee ROM (measured through knee extension and flexion).
METHODS: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
摘要：
目的：报告一系列用于治疗胫骨平台关节内畸形的关节外截骨术，并评估矫正畸形和改善膝关节活动范围（ROM）的能力。
方法：。
方法：回顾性病例系列。
方法：学术，第三级,转诊中心。
■在2014年至2023年之间接受股骨和/或胫骨关节外截骨术治疗的胫骨平台骨折畸形愈合的成年患者。
■机械轴偏差（MAD），胫骨近端内侧角(MPTA),股骨远端外侧角(LDFA),和后近端胫骨角（PPTA）校正；膝盖ROM；和负重时间。
结果：纳入7例患者，女性6人(85.7%),男性1人(14.3%)。中位年龄为43.5岁（IQR38.5-51，范围32-62）。4例(57.1%)患者接受胫骨高位截骨术(HTO)治疗,3例(42.9%)患者接受了HTO和股骨远端截骨术。一名患者同时进行了踝上截骨术与HTO以解决胫骨远端切骨术和外翻。四个人接受了六足框架治疗，和3用板和螺钉处理。中位随访时间为22.5个月(IQR10.5-107个月，7-148个月）。手术干预术前相对于术后值校正了外翻错位的中位影像学测量。这包括MAD（42.5mm-0mm），外翻角（12.5度-1.5度），MPTA（95度-88.0°），和LDFA（86.0°-87.3度）。手术干预增加了术前至术后的最大膝关节运动范围。完全负重的中位时间为81.5天(IQR46-57天，范围41-184天）。两名患者在使用六足框架的HTO后5年和10年后转换为全膝关节置换术。
结论：关节外截骨术是治疗胫骨平台骨折后关节内不愈合的有效方法。它在纠正MAD方面是有效的，外翻畸形,MPTA,LDFA,PPTA,并改善膝盖ROM（通过膝盖伸展和屈曲测量）。
方法：治疗级别IV。有关证据级别的完整描述，请参阅作者说明。
方法：。
方法：回顾性病例系列。
方法：学术，第三级,转诊中心。
■在2014年至2023年之间接受股骨和/或胫骨关节外截骨术治疗的胫骨平台骨折畸形愈合的成年患者。
■机械轴偏差（MAD），胫骨近端内侧角(MPTA),股骨远端外侧角(LDFA),和后近端胫骨角（PPTA）校正；膝盖ROM；和负重时间。
结果：纳入7例患者，女性6人(85.7%),男性1人(14.3%)。中位年龄为43.5岁（IQR38.5-51，范围32-62）。4例(57.1%)患者接受胫骨高位截骨术(HTO)治疗,3例(42.9%)患者接受了HTO和股骨远端截骨术。一名患者同时进行了踝上截骨术与HTO以解决胫骨远端切骨术和外翻。四个人接受了六足框架治疗，和3用板和螺钉处理。中位随访时间为22.5个月(IQR10.5-107个月，7-148个月）。手术干预术前相对于术后值校正了外翻错位的中位影像学测量。这包括MAD（42.5mm-0mm），外翻角（12.5度-1.5度），MPTA（95度-88.0°），和LDFA（86.0°-87.3度）。手术干预增加了术前至术后的最大膝关节运动范围。完全负重的中位时间为81.5天(IQR46-57天，范围41-184天）。两名患者在使用六足框架的HTO后5年和10年后转换为全膝关节置换术。
结论：关节外截骨术是治疗胫骨平台骨折后关节内不愈合的有效方法。它在纠正MAD方面是有效的，外翻畸形,MPTA,LDFA,PPTA,并改善膝盖ROM（通过膝盖伸展和屈曲测量）。
方法：治疗级别IV。有关证据级别的完整描述，请参阅作者说明。
