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Reported complication rates for tibial osteotomies have been widely variable and no study has focused on a single deformity etiology, surgical technique, or stabilization method. A review of 38 high tibial osteotomies with external fixation in adolescent Blount's disease patients was performed at two institutions. Results showed an overall complication rate of 153% and an elevated (97%) prevalence of morbid obesity in the patients in this series. This study highlights the potential association between comorbidities and elevated complication rates. Recognition of comorbidities will allow more effective risk stratification and preoperative counseling stressing the importance of compliance, wound, and pin care.