Slope-changing Tibial Osteotomy with Biological Plating

In September 2013 I had a motorcycle accident and had a multi-fragmental tibial plateau fracture, which was plated and screwed to fix the break, but it left me with a bad slope to my tibia. My leg was unusable really - I couldn’t walk on it, it was complete agony..........When I last saw Mr Wilson for a check up I got quite emotional, which I have done a few times with him, but, you know, I said to him "You really have given me my life back and I really appreciate that."

Stephanie
(patient)

Regarding the video above, these two images are both the same lateral view of her injured leg before this osteotomy procedure. You can see the fixation from the original operation, but look above it at the tibial plateau. You can see that it is at a very bad angle (or 'slope'). On the right version we have marked this for you - the plateau is sloping down to the front at an angle of 102 degrees, which is far too much.

In order to correct the slope, the old fracture fixation was removed. A section of tibia with patellar tendon still attached was lifted up, and a wide gap wedged opened at the front of the tibia.

A bone wedge was then inserted into the gap. The size of the opening and the bone wedge had been carefully calculated with our digital planning software.

After the wedge was positioned into the gap, the section of tibia that had been lifted up was not replaced and fixed in place - acting as a biological bone bridge fixation. ​We got the slope to positive 5 degrees so 85 from 102°.


Here we present the stories of two young people who suffered tibial plateau injuries resulting in a negative slope on their tibial plateau. In both cases the situation was very disabling, and we turned their lives around with osteotomy and 'biological plating'.

By 'biological plating' we mean using the sliver of bone from the front of the tibia, which needs to be lifted together with the patellar tendon to give the surgeon access to the front part of the tibia where it  needs to be cut and wedged. The sliver, when brought back to its original position, then unites across the gap as the bone grows back together.

The video testimonial on the left supports the excellent outcome in a young woman, previous very active, whose life was set right back after an accident which left her with a bad slope to the tibial plateau where she had had a fracture reduced and plated, and which had healed in a bad position.

The smaller video below shows a slope-changing and biological plating procedure in a young man - but both patients​ essentially had the same operation.

This video shows the surgical procedure in the young man, but the principle is just the same in the two cases.

On the left of the photo at the front of the video you can see the assistant holding the sliver over bone away to the side so that the surgeon can get access for the osteotomy.

You can also see the gap that has been cut into the tibia at the front. So the gap is then filled with a bone wedge, and the sliver of lifted bone is replaced and fixed back into position to act as the 'biological plate' across the osteotomy area.​


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2 comments
Nishith Shah says April 14, 2016

Slope alteration is a very common problem in India also, due to very badly comminuted fractures of upper tibia or due to floating knee injuries. I also use this commonly in my practice for neglected PCL/ ACL injuries in young peopel ( below 50) who develop arthritis due to undiagnosed ligament injuries. Sometime I combine with ACL reconstruction in a grossly unstable knee

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Adrian wilson says April 29, 2016

Great comments Nishith
Changing the slope is a very powerful tool. It’s great to hear that you are using this technique commonly in your practice
When there is a coronal alignment issue we tend to use a more conventional approach and do a correction from the medial or lateral side. Having said this if the patient is well aligned in the coronal plane then a direct anterior approach is favoured. We also do an anterior approach where we need to achieve a big correction. For PCL deficient knees in the revision situation a slope change is often all you need
Great to hear you are dealing with these complex issues in this way Nishith

Best wishes

Adrian

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