Which osteotomy is associated with a high rate of dorsal malunion?

• A. Crescentic osteotomy
• B. Met base osteotomy
• C. V base osteotomy
• D. Spiral osteotomy

Answer: (A)

Dorsal malunion is most likely when the osteotomy relies on a dorsal cortex hinge and the distal fragment can tilt upward under load. The crescentic osteotomy creates a curved wedge and leaves a relatively small dorsal hinge, so if fixation isn’t very sturdy or weight bearing begins too soon, the dorsal hinge can lose its position and the distal fragment ends up dorsally displaced. That makes dorsal malunion a notable risk with the crescentic pattern. In contrast, base-type and spiral osteotomies create broader contact surfaces and different hinge mechanics that resist dorsal tilt more effectively, resulting in a lower likelihood of dorsal malunion.