A 28-year-old man has a 30 degree varus malunion of the mid-tibial shaft with intact skin and no infection. He wants full correction. Which approach is preferred?

• A Acute closing wedge osteotomy with plate fixation
• B Acute correction with an intramedullary nail alone
• C Gradual correction with a hexapod external fixator ✓
• D Observation, as the deformity will remodel

Explanation

Corrections beyond roughly 10 to 15 degrees of angulation, or those combined with translation, rotation or length change, carry a real risk of neurovascular stretch injury if done acutely. Gradual correction with a spatial frame distributes the soft tissue adaptation over days to weeks and allows simultaneous handling of all deformity components. Remodelling does not occur in an adult, so observation is wrong.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.