Biomechanical effect of a lateral hinge fracture for a medial opening wedge high tibial osteotomy: finite element study

Kang, Kyoung‐Tak; Koh, Yong‐Gon; Lee, Jin-Ah; Lee, Jae Jung; Kwon, Sae Kwang

doi:10.1186/s13018-020-01597-7

Cited by 15 publications

(16 citation statements)

References 53 publications

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“…In type II LHFs, a rotational deformity is formed and leads to delayed union, nonunion, or correction loss. 28 In addition, 1 biomechanical study 7 reported that a stress-shielding effect because of the increased plate stress and reduced bone stress was observed in cases with type II LHFs. Therefore, close observation of valgus collapse and the status of the bony union is necessary during the rehabilitation period for type II LHFs.…”

Section: Discussionmentioning

confidence: 99%

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Prediction and Development of Preventive Strategies for Lateral Hinge Fracture During Opening Wedge High Tibial Osteotomy Based on Osteotomy Configurations

et al. 2021

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Background: Lateral hinge fracture (LHF) is a major complication of opening wedge high tibial osteotomy (OWHTO) and may result in poor outcomes. Purpose/Hypothesis: The purpose of this study was to develop preventive strategies by identifying factors that affect LHFs. We hypothesized that (1) each LHF type would have different affecting factors and that (2) specific operative strategies that can contribute to the prevention of each LHF type can be developed. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively analyzed 261 consecutive knees treated with biplanar OWHTO between March 2014 and December 2017. Perioperative radiological variables that can affect LHFs were measured and divided into 2 categories: unmodifiable and modifiable. A regression model was developed, and subgroup analyses involving comparisons between the non-LHF group and each LHF group were performed. The weightbearing line (WBL) ratio was measured at 2 weeks and 1 year after surgery to determine the serial changes in each LHF type. Results: A total of 66 knees (25.3%) were diagnosed with LHFs. From these, 26 (39.4%), 13 (19.7%), 15 (22.7%), and 12 (18.2%) showed type I, II, III, and I-variant LHFs, respectively. In the subgroup analysis, a larger posterior gap and distance X and a smaller fibular height (FH) were significant unmodifiable factors, while the retrotubercular thickness was a significant modifiable factor, for type I LHF. For type II LHF, a smaller lateral condylar slope and a larger distance X were significant unmodifiable factors, while the lateral distal fragment thickness and the osteotomy-condylar angle were significant modifiable factors. For type III LHF, a larger lateral condylar width and distance X and a smaller FH were significant unmodifiable factors, while the lateral proximal fragment thickness and the retrotubercular angle (RA) were significant modifiable factors. A smaller FH and a larger distance X were significant unmodifiable factors for type I-variant LHFs, while the lateral thickness ratio and the RA were significant modifiable factors. Between postoperative week 2 and 1 year, the WBL ratio decreased in cases with type I LHFs ( P < .001) and increased in those with type II ( P = .001) and type I-variant ( P = .006) LHFs. Conclusion: Unmodifiable and modifiable factors for the development of LHFs after OWHTO differ among LHF types. To prevent LHFs, the causes of each LHF must be identified, the patient’s specific geometry be considered in the preoperative planning, and the surgical technique be modified according to the modifiable factors. In addition, during the rehabilitation period after OWHTO, specific caution and close observation are necessary for alignment changes related to each LHF type.

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Section: Discussionmentioning

confidence: 99%

“…Type III fractures are unstable intra-articular fractures because the proximal fragment is only supported by the medial plate. 7 Therefore, we performed screw fixation for type III LHFs, which were mostly diagnosed intraoperatively. In addition, a hinged brace was applied and weightbearing was delayed until 6 weeks after surgery.…”

Section: Discussionmentioning

confidence: 99%

Prediction and Development of Preventive Strategies for Lateral Hinge Fracture During Opening Wedge High Tibial Osteotomy Based on Osteotomy Configurations

et al. 2021

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“…A relative high-stress area appeared near the outside corner and the D-hole of the medial TomoFix plate in HTO, particularly with LHFs in the present study. In the previous FE study [ 15 ], the stress of the plate was also increased, particularly in the T2 and T3 LHFs. The high stress after LHFs can create a crack and then extend to the screw hole after cyclic loading during postsurgical walking without bone healing.…”

Section: Discussionmentioning

confidence: 84%

“…Many studies have investigated LHF incidence after HTO and complications following LHFs. The biomechanical effect of the LHFs on the HTO with medial opening wedge and the bone plate was also revealed [15]. In the study, the stress of the medial plate was increased with the LHFs.…”

Section: Introductionmentioning

confidence: 78%

Computational comparison of different plating strategies in medial open-wedge high tibial osteotomy with lateral hinge fractures

et al. 2020

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Background Lateral hinge fracture (LHF) is associated with nonunion and plate breakage in high tibial osteotomy (HTO). Mechanical studies investigating fixation strategies for LHFs to restore stability and avoid plate breakage are absent. This study used computer simulation to compare mechanical stabilities in HTO for different LHFs fixed with medial and bilateral locking plates. Methods A finite element knee model was created with HTO and three types of LHF, namely T1, T2, and T3 fractures, based on the Takeuchi classification. Either medial plating or bilateral plating was used to fix the HTO with LHFs. Furthermore, the significance of the locking screw at the combi hole (D-hole) of the medial TomoFix plate was evaluated. Results The osteotomy gap shortening distance increased from 0.53 to 0.76, 0.79, and 0.72 mm after T1, T2, and T3 LHFs, respectively, with medial plating only. Bilateral plating could efficiently restore stability and maintain the osteotomy gap. Furthermore, using the D-hole screw reduced the peak stress on the medial plate by 28.7% (from 495 to 353 MPa), 26.6% (from 470 to 345 MPa), and 32.6% (from 454 to 306 MPa) in T1, T2, and T3 LHFs, respectively. Conclusion Bilateral plating is a recommended strategy to restore HTO stability in LHFs. Furthermore, using a D-hole locking screw is strongly recommended to reduce the stress on the medial plate for lowering plate breakage risk.

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“…The advantages and shortcomings of the plate adapting techniques, raises the question that “what level of geometrical fit with the underlying bone is appropriate for a HTO locking plate fixation?” The previous studies on the biomechanics of the HTO fixation have often neglected this question and focused on the effects of different plate designs, for example, Puddu (Arthrex Ltd, Naples, FL, USA), 16–18 Tomofix (Arthrex Ltd, Naples, FL, USA), 16–28 Limmed, 29 Activemotion (Newclip Technics, Haute-Goulaine, France), 26 iBalance (Arthrex, Munich, Germany), 24,26 Contour Lock (Arthrex, Munich, Germany), 24,26 PEEKPower (Arthrex, Munich, Germany), 20,24,26 and LCfit (Corentec, Cheonan-si, South Korea), 23 as well as the screw types 19,22,25,30 and configurations, 27 on the fixation stability. In fact, we found only a single study 31 addressing the influence of plate contouring on the biomechanical performance of the HTO fixation.…”

Section: Introductionmentioning

confidence: 99%

Effects of plate contouring quality on the biomechanical performance of high tibial osteotomy fixation: A parametric finite element study

Hayatbakhsh

Farahmand

2022

Proc Inst Mech Eng H

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Locking plates have threaded holes, in which threaded-head screws are affixed. Hence, they do not need to be in intimate contact with underlying bone to provide fixation. There are, however, reports that a large distance between the plate and the bone might cause clinical complications such as delayed union or nonunion, screw pull out, and screw and plate breakage. Considering the diversity in the capabilities and costs of different plate customization techniques, the purpose of this study was to investigate the effect of the plate contouring quality on the biomechanical performance of high tibial osteotomy (HTO) fixation. A finite element model of proximal tibia was developed in Abaqus, using the QCT data of a cadaver. The model was then subjected to open-wedge HTO (correction angle 12°) with TomoFix plate fixation. The sagittal curvature of the plate was changed parametrically to provide certain levels of geometrical fit, and the biomechanical performance parameters of fixation were assessed. Results indicated 5%, 9% and 38% increase in the stiffness of the construct, and the von Mises stress in the plate and locking screw just above the osteotomy site, respectively, when the level of fit of plate changed from 0% (initial non-contoured initial shape) to 100% (fully adapted shape). The same change decreased the pressure at the lateral hinge of the osteotomy by 61%, and the mean of the tensile stress on the screw shaft by 12%. It was concluded that the level of fit has conflicting effects on the biomechanical parameters of the HTO fixation system, that is, the structural stiffness, the pressure at the lateral hinge, the stresses in the plate and screws, and the pull out resistance of the screws. In particular, for HTO patients with high quality bone, the optimal level of fit should provide a tradeoff between these parameters.

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Biomechanical effect of a lateral hinge fracture for a medial opening wedge high tibial osteotomy: finite element study

Cited by 15 publications

References 53 publications

Prediction and Development of Preventive Strategies for Lateral Hinge Fracture During Opening Wedge High Tibial Osteotomy Based on Osteotomy Configurations

Prediction and Development of Preventive Strategies for Lateral Hinge Fracture During Opening Wedge High Tibial Osteotomy Based on Osteotomy Configurations

Computational comparison of different plating strategies in medial open-wedge high tibial osteotomy with lateral hinge fractures

Effects of plate contouring quality on the biomechanical performance of high tibial osteotomy fixation: A parametric finite element study

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