closingwedge

Closing wedge osteotomy, sometimes written closing-wedge, is an orthopedic surgical technique used to correct angular deformities in long bones by removing a wedge-shaped piece of bone and closing the gap. The most common application is the proximal tibia to correct varus deformity of the knee, such as that seen in medial compartment osteoarthritis, but the method is also employed in the femur and other long bones.

Planning and technique: Preoperative planning uses imaging to determine the corrective angle. A wedge of bone is removed from the side opposite the deformity—typically the medial side in a varus knee—so that when the osteotomy ends are brought together, the limb is realigned toward valgus. The ends are then stabilized with plates and screws, a compression device, or an external fixator. The bone ends usually contact across the osteotomy, so grafting is not always required.

Advantages and considerations: Closing wedge osteotomy provides predictable angular correction and can preserve more joint space in certain scenarios. It may shorten the limb slightly, unlike some opening wedge approaches. Risks include nonunion, infection, nerve injury (notably to the peroneal nerve), over- or under-correction, and hardware problems. Accurate planning and precise execution are essential for good outcomes.

Recovery and outcomes: Postoperative rehabilitation typically involves staged weight-bearing and gradual range-of-motion exercises. Healing takes weeks to months. Long-term results depend on alignment accuracy, patient age, and the underlying joint condition; many patients experience pain relief and improved function.

See also: opening wedge osteotomy; high tibial osteotomy; limb deformity correction.