{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:37:05Z","timestamp":1787755025274,"version":"build-2784847793"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Case:<\/jats:title>\n                    <jats:p>Here, we describe a case of a 49-year-old female patient with a history of hypertension and polysubstance use disorder presenting with a distal tibial metaphyseal malunion treated with a clamshell osteotomy. Her follow-up was 2.5 years long.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Malunions in the tibial diaphysis and distal metaphysis can cause significantly increased joint reaction forces and altered gait mechanics leading to cosmetic dissatisfaction and decreased quality of life for these patients. Correction of these deformities can improve patient satisfaction and quality of life, along with decrease the risk of early arthritis. The clamshell osteotomy, although initially described to treat diaphyseal long bone malunions, can safely be performed for treatment of complex periarticular metaphyseal malunions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.cc.23.00072","type":"journal-article","created":{"date-parts":[[2023,8,9]],"date-time":"2023-08-09T14:02:15Z","timestamp":1691589735000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Distal Tibial Metaphyseal Malunion Treated with Clamshell Osteotomy"],"prefix":"10.2106","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7579-5691","authenticated-orcid":false,"given":"Christon","family":"Darden","sequence":"first","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7397-8478","authenticated-orcid":false,"given":"Amit","family":"Pujari","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5143-3754","authenticated-orcid":false,"given":"Carolina","family":"Stocchi","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Forsh","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,7]]},"reference":[{"issue":"9","key":"bib1-20240805","doi-asserted-by":"crossref","first-page":"951","DOI":"10.3390\/medicina57090951","article-title":"The clamshell osteotomy for diaphyseal malunion in deformity correction and fracture surgery","volume":"57","author":"Purcell","year":"2021","journal-title":"Medicina (Kaunas, Lithuania)."},{"issue":"suppl 1 Pt 2)","key":"bib2-20240805","doi-asserted-by":"crossref","first-page":"158","DOI":"10.2106\/JBJS.I.01328","article-title":"The clamshell osteotomy: a new technique to correct complex diaphyseal malunions: surgical technique","volume":"92","author":"Russell","year":"2010","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib3-20240805","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/0020-1383(94)90125-2","article-title":"Osteosynthesis of 245 tibial shaft fractures: early and late complications","volume":"25","author":"Bilat","year":"1994","journal-title":"Injury."},{"issue":"5","key":"bib4-20240805","doi-asserted-by":"crossref","first-page":"640","DOI":"10.2106\/00004623-199705000-00002","article-title":"Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft. 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