{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:32:30Z","timestamp":1792603950439,"version":"4.5.0"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:sec>\n            <jats:title>OBJECTIVES:<\/jats:title>\n            <jats:p>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).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>\u2009<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Retrospective case series.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>Academic, tertiary, referral center.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patient Selection Criteria:<\/jats:title>\n            <jats:p>Adult patients with tibial plateau fracture malunion treated with extra-articular osteotomy of the femur and\/or tibia between 2014 and 2023.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Outcome Measures and Comparison:<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>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\u201351, range 32\u201362). 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\u2013107 months, range 7\u2013148 months). Surgical intervention corrected median radiographic measures of valgus malalignment preoperatively relative to postoperative values. This included MAD (42.5 mm\u20130 mm), valgus angle (12.5 degrees\u20131.5 degrees), MPTA (95 degrees\u201388.0\u00b0), and LDFA (86.0\u00b0\u201387.3 degrees). Surgical intervention increased maximal knee range of motion preoperatively to postoperatively. Median time to full weight bearing was 81.5 days (IQR 46\u201357 days, range 41\u2013184 days). Two patients were converted to total knee arthroplasty after 5 and 10 years following HTO with hexapod frame.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>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).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>LEVEL OF EVIDENCE:<\/jats:title>\n            <jats:p>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000002845","type":"journal-article","created":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T18:00:31Z","timestamp":1716228031000},"page":"441-446","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Extra-articular Osteotomy for the Management of Intra-articular Tibial Plateau Valgus Malunion"],"prefix":"10.1097","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8636-8249","authenticated-orcid":false,"given":"Brian Joseph","family":"Page","sequence":"first","affiliation":[{"name":"Hospital for Special Surgery, Orthopaedic Trauma Service, New York, NY;"},{"name":"New York Presbyterian\u2014Weill Cornell Medical Center, Orthopaedic Trauma Service, New York, NY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Greenstein","sequence":"additional","affiliation":[{"name":"University of Michigan College of Medicine, Ann Arbor, MI;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard A.","family":"Sheridan","sequence":"additional","affiliation":[{"name":"University Hospital Galway, Department of Orthopaedic Surgery, Galway, Ireland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Austin T.","family":"Fragomen","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, Limb Lengthening and Complex Reconstruction Service, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Robert","family":"Rozbruch","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, Limb Lengthening and Complex Reconstruction Service, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250614","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1530\/EOR-22-0004","article-title":"Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management","volume":"7","author":"G\u00e1lvez-Sirvent","year":"2022","journal-title":"EFORT Open Rev."},{"key":"R2-20250614","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/j.arthro.2016.08.027","article-title":"Medial open wedge high tibial osteotomy for varus malunited tibial plateau fractures","volume":"33","author":"Sundararajan","year":"2017","journal-title":"Arthroscopy"},{"key":"R3-20250614","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s11420-016-9529-1","article-title":"Early revision surgery for tibial plateau non-union and mal-union","volume":"13","author":"Van Nielen","year":"2017","journal-title":"HSS J."},{"key":"R4-20250614","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1097\/BOT.0000000000001280","article-title":"Early revision surgery for tibial plateau fractures","volume":"32","author":"Kloen","year":"2018","journal-title":"J Orthop Trauma"},{"key":"R5-20250614","doi-asserted-by":"crossref","first-page":"e421","DOI":"10.1097\/BOT.0000000000001304","article-title":"Knee stiffness after tibial plateau fractures: predictors and outcomes(OTA-41)","volume":"32","author":"Kugelman","year":"2018","journal-title":"J Orthop Trauma"},{"key":"R6-20250614","first-page":"321","article-title":"Tibial plateau fractures-does non anatomic reduction lead to an adverse outcome? 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