Opposite cortical fracture in high tibial osteotomy: lateral closing compared to the medial opening‐wedge technique

Abstract

Background and purpose The aim with high tibial valgus osteotomy (HTO) is to correct the mechanical axis in medial compartmental osteoarthritis of the knee. Loss of operative correction may threaten the long-term outcome. In both a lateral closing-wedge procedure and a medial opening-wedge procedure, the opposite cortex of the tibia is usually not osteotomized, leaving 1 cm of bone intact as fulcrum. A fracture of this cortex may, however, lead to loss of correction; this was examined in the present study.Patients and methods We used a prospective cohort of 92 consecutive patients previously reported by Brouwer et al. (2006). The goal in that randomized controlled trial, was to achieve a correction of 4 degrees in excess of physiological valgus. In retrospect, we evaluated the 1-year radiographic effect of opposite cortical fracture. Opposite cortical fracture was identified on the posteroanterior radiographs in supine position on the first day after surgery.Results 44 patients with a closing-wedge HTO (staples and cast fixation) and 43 patients with an openingwedge HTO (non-angular-stable plate fixation) were used for analysis. 36 patients (four-fifths) in the closingwedge group and 15 patients (one-third) in the opening-wedge group had an opposite cortical fracture (p < 0.001). At 1 year, the closing-wedge group with opposite cortical fracture had a valgus position with a mean HKA angle of 3.2 (SD 3.5) degrees of valgus. However, the opening-wedge group with disruption of the opposite cortex achieved varus malalignment with a mean HKA angle of 0.9 (SD 6.6) degrees of varus.

Medial Open Wedge High Tibial Osteotomy: Can Delayed or Nonunion Be Predicted?

“…By contrast, we found that the presence of a lateral cortical hinge fracture was not a risk factor for developing nonunion. Previous work reported that an intact lateral cortical hinge is important to provide stability and to prevent lateral displacement [22]. Furthermore, it has been suggested that instability resulting from a fracture of the lateral cortical hinge could lead to nonunion.…”

“…Factors that can lead to problems in bone healing are loss of correction resulting from hardware failure [4,16,20] and lateral cortical hinge fracture [1,19,22]. In the past decade, new angle-stable fixation implants have made the medial open wedge HTO technique more popular as a result of the higher loading capacity and the high residual stability after failure of the lateral cortex [1].…”

Bovine xenograft locking Puddu plate versus tricalcium phosphate spacer non-locking Puddu plate in opening-wedge high tibial osteotomy: a prospective double-cohort study

“…Although this event occurred in both groups (11 % in the xenograft and 8 % in the tricalcium phosphate groups), we found loss of correction with lateral cortical fracture only in the patients of the tricalcium phosphate group. Adequate strength of the construct can prevent the loss of correction, despite the onset of lateral cortical fracture [25].…”

Total knee arthroplasty after high tibial osteotomy: a comparison of opening and closing wedge osteotomy

“…In association with these concerns, weight bearing is usually allowed later than closing wedge osteotomies. In cases of deformities, greater than 10-15°lateral hinge rupture and loss of correction can occur [23]. Other disadvantages are slight tibial lengthening and low patella.…”