In this clinical case, discover which therapeutic option the team chose to treat a tibia fracture complicated by leg deformity in a 54-year-old active patient, where prosthetic replacement was nearly impossible due to the severity of the deformity.
Matthieu Ollivier is currently a Professor of Orthopaedic Surgery at the Institute of Movement and Locomotion (Chairman: Pr Jean-Noel Argenson) at Aix-Marseille University Hospital, in Marseille, France. His clinical practice is dedicated to knee-related procedures, with a special focus on sports injuries (cartilage, meniscus, ligaments) and osteotomies. He is engaged in an academic field at Aix-Marseille University, teaching medical students, interns, orthopedic residents and fellows.
- 54 y.o. man
- Suffering of flessum and leg deformity
- Extension : -20° / flexion : 70°
- No infection signs
- No skin suffering
- Medical history:
- 8 months ago : proximal tibia fracture, direct trauma
- Hit by snowboarder meanwhile skiing,
- Immediate surgery in another center
Post traumatic scan
Clinical presentation
8 Months xrays
Knee stable but stiff walk without crusches
How would you manage this condition?
- ✔️You plan an osteotomy
What’s the right answer about this case ?
- ✔️Only option to manage high tibial slope and severe tibial varus is a tibial plateau leveling osteotomy
- Hardware Removal
- Tibial plateau leveling osteotomy
- Elevation of the inverted dome (only) medially
- Fixation with 2 plates
- The objective was to preserve the native articulation and cartilage, (which is not so bad), correct the slope and the varus in the same procedure to treat the flexum and achieve proper alignment for a possible future simple TKA.
Pre-operative planning
Aimed for slight varus (symetric)
Intra-operative pictures
Post-operative X-Rays
1 month
- Complete extension
- Flexion 140
- Symetric varus
- Ami
