PMC6176307_01
(a) Leg length view showing 30 degrees varus of tibia and several osteoarthritis left knee. (b) Lateral view showing 20 degrees apex anterior angulation at malunited fracture site.
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He also had severe tricompartmental osteoarthritis on the left knee (Figures 1(a) and 1(b)).
CT scan:malunited fracture of the middle third left tibia.
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A CT scan confirmed the presence of malunion (Figure 2).
(a, b) Internal fixation after clamshell osteotomy. (b) Blocking screw was used in distal tibia for proper positioning of rod which helped correction of deformity.
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Tibia was properly aligned and "blocking screw" was placed laterally on the distal fragment to maintain corrected varus position of tibia (Figures 3(a) and 3(b)). Nail was locked with two proximal and two distal locking screws (Figures 3(a) and 3(b)).
(a-d) Postoperatively showing good healing at fracture site at 6 months.
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Radiologic healing of fracture was confirmed by three cortices healing on X-ray at 6 months (Figures 4(a)-4(d)).
Total knee replacement after removing proximal tibial nail screws. Removal of IM nail was not indicated.
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Postoperative X-rays showed good alignment (Figure 6).