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hi this is dr. Rob Rosberg from HSS were going to go over a high tibial osteotomy for bowlegs correction you see the patient is positioned supine the medial side is approached through a seven centimeter incision just at the proximal part of the tibia affected down to the bone guide wires are inserted to plan the orientation of the osteotomy the Asiata me started on the medial side follows the orientation of the pens part of the osteotomy is oblique so as to avoid the tibial tubercle the lateral cortex is not cut an osteotome is used to further spread and complete the osteotomy and laminar spreaders are used to open the osteotomy the precise amount to correct the deformity plan preoperatively based on radiographic planning and is confirmed intraoperatively in surgery the opening wedge is maintained with the laminar spreaders and a locking plate is then inserted it can be slid under the skin so as to avoid a large incision locking screws are then inserted these are typically five milli