Lateral Closing Wedge HTO

 

 

lateral closing HTO

 

Technique

 

Vumedi surgical techique video

 

Position

- supine on radiolucent table

 

Incision with knee at 90°

- midpoint tibial tuberosity & fibular head

- extend proximally

- incise deep fascia / ITB in line with incision

- reflect underlying Tibialis anterior & EDL to expose tibia

- expose proximal tibia anteriorly and posteriorly

- homan retractor anteriorly under patella tendon

- dissect soft tissue subperiosteally off posterior tibial cortex

- retractor to protect posterior structures

 

Release Tibio-fibular joint

- protect the CPN by staying superior to neck

- insert osteotome into joint +/- remove sliver of head medial fibular head

 

Osteotomy

- guide wires at superior level osteotomy

- 2cm distal to joint in AP and lateral

- parallel to joint in AP and lateral plane

- inferior guide pins at level of desired wedge

- attempt to leave medial cortex intact

- try to remove wedge of bone intact

- medial aspect of wedge difficult to remove

 

Check correction

- drop rod

- Fujisawa point

 

Stabilise osteotomy with plate

 

Complications

 

Medial hinge fracture

 

HInge fractureHTO Lateral Closing Wedge AP 1HTO Closing Wedge Medial Fracture Callous

 

van Raaij et al Acta Orthop 2008

- 44 closing wedge HTO

- 36/44 (82%) had fracture

- no significant malunion

 

Undercorrection

 

HTO Insufficient CorrectionHTO undercorrection

 

CPN injury / compartment syndrome / foot drop / EHL weakness

 

Mechanism

- direct injury to CPN during proximal tibio-fibular joint release

- injury to nerve branches to EHL

- compartment syndrome from elevated anterolateral compartment pressures