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High tibial osteotomy is a reliable procedure for the correction of knee varus deformity. An opening-wedge high tibial osteotomy (OW-HTO) is the most popular technique. The results of the bone defect after opening the wedge needed special treatment to ensure bone healing. This study aims to evaluate the use of bovine-derived hydroxyapatite graft for defect filling after OW-HTO., Methods: A retrospective study was performed on all patients who received OW-HTO at Prof. Dr R. Soeharso Orthopaedic Hospital from November 2019 to December 2022. A total of 21 patients (24 knees) were included in this study. Clinical dan radiological evaluation was performed on all patients preoperative and postoperatively. The mean of the follow-up period was 12.6 months with a minimum of 4 months follow-up., Results: Primary medial uni-compartment knee osteoarthritis was the most common diagnosis, with 17 of 24 cases (70.8%). Mechanical axis deviation was changed from 31 mm medial deviation (range: 8-52 mm) to 0.45 mm medial deviation (range: 13 - (-8) mm). The anatomic tibiofemoral angle was corrected from a preoperative mean of 4.7 ° of varus to a mean of 5.8 ° of valgus postoperatively. Bone defect height was mean 15.9 mm with a range of 10-23 mm. Bone defect width was mean 46.7 mm (range: 34-60 mm). Hydroxyapatite graft integration with the host bone was found in all patients during the final follow-up period., Conclusions: Bovine-derived hydroxyapatite graft is a safe and effective material for bone defect filling in OW-HTO procedures with a high bone union rate., Competing Interests: The authors declare that they have no financial conflict of interest with regard to the content of this report., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Osteoarthritis is one of the leading causes of disability and the most common degenerative disease of the knee that causes enormous pain. As many as 10-15 % of patients requiring total knee arthroplasty (TKA) present with valgus knee deformity. When fully constrained TKA is not possible, the surgeon must use a different method to achieve a good result., Case Description: A 56-year-old female with 3rd degree (48-degree) and a 62-year-old male with 2nd degree valgus knee (13-degree) with painful osteoarthritis were examined. Both have valgus thrust gait and medial collateral ligament (MCL) laxity and underwent TKA using non-constrained implants. During surgical exposure, MCL insufficiency was found in both patients, and MCL augmentation was performed. Post-operative assessment and 4-month follow-up were done through clinical and radiological parameters using the knee scoring system., Discussion: A good outcome could still be achieved with a primary TKA implant in severe and moderate valgus knees with MCL insufficiency using MCL augmentation. The primary TKA implant proved to improve clinical and radiological parameters after 4 months of follow-up. Clinically, both patients no longer felt pain in their knees and were able to walk with better stability. Radiologically, there was a much-reduced valgus degree. The results were the first case went from 48-degree to 2-degree and the second case went from 13-degree to 6-degree., Conclusion: Knee osteoarthritis with valgus deformity and MCL insufficiency present surgical challenges during TKA. It is still possible to use in severe or moderate valgus with MCL insufficiency, which was proven by satisfactory clinical and radiological findings. Although a non-constrained option is not ideal, it is still the first choice in certain cases., Competing Interests: Declaration of competing interest N/A., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction and Importance: Tibial plateau fractures are often accompanied by soft tissue compromise, especially in Schatzker 5 and 6, caused by high-energy trauma. In this situation, more careful consideration is needed. A rush decision will result in morbidity, bad postoperative wounds, and infections resulting in dehiscence., Case Presentation: We have three patients with the tibial plateau. In the first case, ORIF was still performed on the fracture with soft tissue compromised. The patient was found to have wound dehiscence resulting in an implant-exposed bone. In the subsequent two cases, Patients with tibial plateau Schatzker 6 fractures also showed blisters around their injured knees. We performed hybrid external fixation. Screwing fixation was performed to obtain compression. Kirschner wire 2.2 formed a raft configuration attached to the semicircular frame and uniplanar external fixation to support the tibial plateau., Clinical Discussion: A hybrid external fixation is an excellent option for treating tibia plateau fractures with compromised soft tissue. It can achieve early fracture fixation while avoiding soft tissue problems; thus, the patients can start early rehabilitation., Conclusion: A hybrid external fixation can be applied to tibial plateau fractures with soft tissue compromised without waiting for subsiding and has satisfactory clinical and radiological outcomes. The author also explains this case report's hybrid external fixation technique., Competing Interests: Conflict of interest statement All authors state that there are no financial and personal relationships with other people or organizations that could inappropriately influence (bias) for this cases report., (Copyright © 2023. Published by Elsevier Ltd.)