Bi-planar intra-articular deformity following malunion of a Schatzker V tibial plateau fracture: Correction with intra-articular osteotomy using patient-specific guides and arthroscopic resection of the tibial spine bone block.

Abstract

Malunited tibial plateau fractures are a surgical challenge. We report a case of a malunion following a Schatzker V tibial plateau fracture with a biplanar deformity of the medial hemi-plateau. This was treated with an intra-articular osteotomy and biplanar restoration of the medial hemi-plateau using patient-specific guides and 3-dimensional planning based on computed tomography (CT) images. The mechanical axis was paradoxically preserved and the lateral compartment showed evidence of overload and degeneration secondary to a malunited tibial spine bone block providing varus/valgus constraint. This was arthroscopically resected at the same sitting. The tibial plateau was restored to the desirable height with a vast improvement in function and pain levels.