PMC6126075_01
(a) Initial posttraumatic anteroposterior radiographs of the right tibia and fibula. (b-c) Anteroposterior and lateral radiographs of the right tibia obtained (b) immediate postoperatively and (c) 1 year postoperatively. (d) Photograph. (e) Computed tomography (CT) images of the right and left tibia of the patient show external tibial torsion.
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A 49-year-old man sustained a tibial shaft spiral fracture (AO/OTA classification 42-A2) with a fibular fracture (Figure 1(a)). The fracture was treated initially at another hospital with a reamed statically locked intramedullary nail (Figure 1(b)). The tibial fracture united after a year (Figure 1(c)), but he still complained of the asymmetry of his legs, difficulty walking and running, and inability to ride a bicycle. Computed tomography (CT) of both tibias showed 24  of increased external rotation of the affected leg (Figures 1(d), 1(e)).
Photographs. (a) Small incision at the original fracture site. (b) Two 3.0 mm Kirschner wires were inserted as guides for correction. (c) Kirschner wires used as a guide for correcting the angle between the proximal and distal bones, which are matched in a straight line.
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Osteotomy for the affected tibia was performed percutaneously using an osteotome on the prepared osteotomy line while retaining the intramedullary nail (Figure 2(a)). Next, two 3.0 mm Kirschner wires, which created a 24  rotational angle in the axial plane between the bone fragments, were inserted as guides for correction (Figure 2(b)). After matching the two Kirschner wires in a straight line, correct rotation was confirmed (Figure 2(c)).
(a) Anteroposterior and lateral radiographs of the right tibia obtained immediately after corrective osteotomy. (b) CT images of the right and left tibias obtained 1 year after corrective osteotomy. (c) Anteroposterior and lateral radiographs of the right tibia obtained 5 years after corrective osteotomy.
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Finally, the distal three locking screws were inserted into holes different from the original hole (Figure 3(a)). The appropriate correction of the rotational deformity was confirmed on a CT scan (Figure 3(b)). Postoperative follow-up was continued until 5 years after the corrective osteotomy (Figure 3(c)).