Table 1.

Pearls and Pitfalls

Pearls	Pitfalls
The use of a radiolucent retractor to protect the posterior neurovascular structures allows the surgeon to fluoroscopically access the osteotomy without having to remove the retractor to verify pin or osteotome position.	Opening proximal tibial osteotomy has been reported to increase the posterior tibial slope. Measuring the sagittal slope preoperatively helps planning the best position for the plate
Slow progression in the opening of the osteotomy using a specific spreader device and leaving it in place for 5 minutes to allow for stress relaxation of the lateral cortex can minimize the risk of an undesired fracture	Intra-articular tibial fracture is a possible complication. Keeping at least 1.5 cm of bone between the osteotomy and the cartilage on the coronal view minimizes this risk
The fixation plate may need to be bent to better conform to the tibia surface	Extra-articular fracture extending to the lateral tibial cortex may happen. Leave 1 cm of bone bridge on the lateral side to avoid this complication.
Be aware of the bowl shape of the medial tibial plateau when placing the proximal screws to avoid damage to the joint.	If the lateral tibial cortex is damaged, a staple can be placed to prevent further propagation and stabilize the cortex
Placing a large Richards staple anteriorly while hyperextending the knee prevents the sagittal plane correction from altering postoperatively	Consolidation problems may happen with opening wedge osteotomies. Preserving local biology and filling the gap with bone graft when it is greater than 10 mm minimizes the risk of this complication.
Place an immobilizer brace after surgery to prevent loss of correction but begin early assisted knee mobilization to prevent adhesions.	Advise your patient to avoid smoking and the use of nicotine products to prevent consolidation problems.