Inverted V-shaped high tibial osteotomy for severe tibia vara associated with Turner syndrome: A case report and review of literature

INTRODUCTION: Severe cases of genu varum represent a major challenge in obtaining normal configuration of the proximal tibia and overall limb alignment. PRESENTATION OF CASE: We performed inverted V-shaped high tibial osteotomy (HTO) by using a locking plate for recurrent severe bilateral tibia vara in a 15-year-old female patient with Turner syndrome. Preoperative medial proximal tibial angle (MPTA) and standing femorotibial angle (FTA) of the right/left legs were 67°/69° and 197°/203°, respectively. In order to obtain overall neutral alignment, the correction angle in the right/left knees was required to be 23°/32°. Preoperative planning demonstrated that inverted V-shaped HTO could provide sufficient correction angle with large bone stock and wide bony contact. A postoperative full-standing radiograph showed that the mechanical axes passed through the center of right/left knees with 87°/88° of MPTA. DISCUSSION: Inverted V-shaped HTO has advantages, as it requires a smaller amount of bone resection and smaller opening gap compared to the closing-wedge and opening-wedge osteotomies. CONCLUSION: Inverted V-shaped HTO can be a useful surgical method to treat severe tibia vara in order to obtain adequate configuration of the proximal tibia and overall limb alignment.