INTEGRATIVE MANAGEMENT OF TIBIAL PLATEAU FRACTURE AND MEDIAL GONARTHROSIS WITH HIGH TIBIAL OPEN WEDGE OSTEOTOMY: A COMPREHENSIVE CASE STUDY
Keywords:
Tibial plateau fracture, post-traumatic osteoarthritis, high tibial open-wedge osteotomy, varus deformityAbstract
Post-traumatic knee osteoarthritis (PTOA) is a significant long-term complication of tibial plateau fractures (TPFs), leading to joint degeneration and impairment. This study presents a comprehensive case analysis of a 72-year-old male diagnosed with a Schatzker Type VI tibial plateau fracture after a high-energy trauma, managed through a staged surgical approach. Initial open reduction and internal fixation (ORIF), achieved fracture alignment, leaving a residual varus deformity, accelerating medial compartment degeneration. The patient developed progressive pain (VAS score: 7/10), restricted mobility (KSS score: 45), and radiographic signs of osteoarthritis within six months post-ORIF.
A high tibial open wedge osteotomy (OWHTO) was performed to correct varus malalignment, redistribute mechanical loads, and delay the need for total knee arthroplasty (TKA). Preoperative radiographs determined a correction angle for biomechanical restoration. The osteotomy was stabilized using a TomoFix locking plate, and rehabilitation followed a structured weight-bearing protocol. At the three-year follow-up, the patient demonstrated pain relief (VAS: 2/10), functional recovery (KSS: 82), and joint stability, returning to daily activities with minimal limitations.
This study shows the critical role of OWHTO in managing post-traumatic gonarthrosis, as a joint-preserving alternative to early TKA. It explores biomechanical principles, surgical considerations, and rehabilitation strategies advocating for staged interventions in complex knee trauma to optimize long-term function.
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