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Complications of High Tibial Osteotomy

- Discussion:
    - osteonecrosis of proximal fragment;
    - non union if proximal fragment is too thin;
         - delayed union or nonunion occurs in 1-3% of pts & is treated by bone grafting or by repeat osteotomy when correction is lost;
         - ref: Results of surgical treatment for non-union after high tibial osteotomy in osteoarthritis of the knee.
                 The treatment of nonunion of proximal tibial osteotomy with internal  fixation.
    - neurologic injuries:
         - have been reported in 1% to 10% of pts;
         - injury to peroneal nerve is increased when external fixation is used, osteotomy of fibular head has
                been performed, or corrections greater than 15 deg have been attempted;
    - incomplete correction:
         - inadequate correction of the varus deformity will often lead to recurrence of symptoms;
    - fracture through proximal fragment with violation of joint space
 - stay at least 2cm from joint line to prevent fracture
    - deep venous thrombosis;
    - compartment syndrome:
         - may initially present as a "delayed peroneal nerve palsy";
         - despite the strong denials from the anesthesiologists, a compartment syndrome can be completely masked by an epidural anesthetic;
                - you only need to see the consequences of this one time to know the truth;
         - case example:
                - 14 yr old male w/ Vit D Resistant Rickets underwent a valgus opening wedge osteotomy for genu varum and received a
                        continuous epidural anesthetic;
                       - in the recovery room, the patient had 5/5 EHL function;
                       - over the ensueing 24 hrs, EHL function was lost, and the patient was felt to have a delayed peroneal palsy;
                       - at 3 days postop, the decision was made to explore the peroneal nerve, at which time it was noted that the patient had 
                               complete necrosis of the anterior compartment;
                       - in retrospect, the patient's delayed peroneal palsy was a progressive compartment syndrome which was completely masked 
                               by the epidural anesthetic