Approach to Proximal Tibial Fracture with Valgus Deformity
Proximal tibial metaphyseal fractures are usually amenable to closed treatment in extension – it is not a bad idea to try to get a bit of OVERcorrection into varus. Some periosteum can get entrapped in the medial part of the fracture which can prevent an anatomic reduction – if the reduction is unacceptable, you can go in and reduce this periosteum.
For reasons that are not totally well understood, they tend to drift into valgus once healed.
The treatment or valgus deformity post-healing is controversial.
– wait until early adolescence – osteotomizing them early may simply lead to recurrence of the deformity
– if spontaneous correction does not occur, do a proximal tibial varus shorteing osteotomy and fibular diaphyseal osteotomy. You can consider doing a medial epiphyseodesis as well.
The key is to WAIT it out.