PMC4972087_01
Clinical picture shows right sided tibia vara.
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A 5 year-old Indian male child presented in June 2013 with unilateral right sided genu varum ( Figure 1) noted since January 2013.
X-ray shows depression of medial tibial plateau with beaking of posteromedial tibial metaphysis.
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X-ray showed depression of medial tibial plateau with beaking of posteromedial tibial metaphysis ( Figure 2) MRI showed an irregular medial physeal line, postero-medial depression, thinning of medial epiphyseal cartilage and concomitant increase in the joint space ( Figure 3).
MRI (coronal PD fat sat image) shows wedge shaped medial epiphysis and deformed physis with altered signal intensity.
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X-ray showed depression of medial tibial plateau with beaking of posteromedial tibial metaphysis ( Figure 2) MRI showed an irregular medial physeal line, postero-medial depression, thinning of medial epiphyseal cartilage and concomitant increase in the joint space ( Figure 3).
Technique of Z-osteotomy - Z shape is marked on the proximal tibia by drill holes which are connected by an osteotome to complete the osteotomy (Shown in red line).. Wedge of bone is removed (Shown in blue shape) and the distal tibia is derotated and then re-engaged in the corrected position. The red line shown on the fibula is the fibular osteotomy.
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A wedge of bone is removed between the vertical and lateral horizontal limb of the Z osteotomy ( Figure 4) and the distal tibia is derotated and angulated laterally then re-engaged in the corrected position.
In-operative picture shows the osteotomy site and post-operative X-rays.. 
a. Close-up view of correction of deformity by Z osteotomy and stabilization with 2 K wires,
b. Varus deformity is corrected to normal alignment,
c. Immediate post-operative X-ray anterior posterior view,
d. Immediate post-operative X-ray lateral view.
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The osteotomy site is then stabilized with one or two k wires ( Figure 5).
Clinical picture of correction at 2 years follow-up.. 
a. Standing front view shows deformity is corrected to normal and comparable to the opposite side,
b. Standing side view shows deformity is corrected,
c. Front view of leg in knee flexed position,
d. Side view of leg in knee flexed position,
e &
f. X-ray AP and lateral view shows consolidation of osteotomy site with normal tibial mechanical axis.
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At the last follow-up in May 2015 child had maintained the correction of angular and rotational alignment ( Figure 6).