Predictive Factors for and Detection of Lateral Hinge Fractures Following Open Wedge High Tibial Osteotomy: Plain Radiography Versus Computed Tomography

Lee, Sung-Sahn; Çelik, Haluk; Lee, Dae-Hee

doi:10.1016/j.arthro.2018.06.041

Cited by 43 publications

(53 citation statements)

References 30 publications

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“…While less extensively investigated to date, similar data have been published for hinge fractures following DFO, with an incidence of 39-46% reported for the LOW-[53], 48% for the MCW- [14] and 31% for In the present study, an increased height of the excised wedge as well as a hinge location close to the medial cortex have been identified as risk factors associated with a medial cortical hinge fracture. This is in accordance with data from HTO, that associated larger osteotomy gaps and location close to the opposite cortex with an increased risk for fracture [20,24,32,33,38,47].…”

Section: Discussionsupporting

confidence: 91%

Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy

Rupp

Winkler

Lutz

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the incidence, morphology, and associated complications of medial cortical hinge fractures after lateral closing wedge distal femoral osteotomy (LCW-DFO) for varus malalignment and to identify constitutional and technical factors predisposing for hinge fracture and consecutive complications. Methods Seventy-nine consecutive patients with a mean age of 47 ± 12 years who underwent LCW-DFO for symptomatic varus malalignment at the authors’ institution between 01/2007 and 03/2018 with a minimum of 2-year postoperative time interval were enrolled in this retrospective observational study. Demographic and surgical data were collected. Measurements evaluating the osteotomy cut (length, wedge height, hinge angle) and the location of the hinge (craniocaudal and mediolateral orientation, relation to the adductor tubercle) were conducted on postoperative anterior–posterior knee radiographs and the incidence and morphology of medial cortical hinge fractures was assessed. A risk factor analysis of constitutional and technical factors predisposing for the incidence of a medial cortical hinge fracture and consecutive complications was conducted. Results The incidence of medial cortical hinge fractures was 48%. The most frequent morphological type was an extension fracture type (68%), followed by a proximal (21%) and distal fracture type (11%). An increased length of the osteotomy in mm (53.1 ± 10.9 vs. 57.7 ± 9.6; p = 0.049), an increased height of the excised wedge in mm (6.5 ± 1.9 vs. 7.9 ± 3; p = 0.040) as well as a hinge location in the medial sector of an established sector grid (p = 0.049) were shown to significantly predispose for the incidence of a medial cortical hinge fracture. The incidence of malunion after hinge fracture (14%) was significantly increased after mediolateral dislocation of the medial cortical bone > 2 mm (p < 0.05). Conclusion Medial cortical hinge fractures after LCW-DFO are a common finding. An increased risk of sustaining a hinge fracture has to be expected with increasing osteotomy wedge height and a hinge position close to the medial cortex. Furthermore, dislocation of a medial hinge fracture > 2 mm was associated with malunion and should, therefore, be avoided. Level of evidence Prognostic study; Level IV.

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Section: Discussionsupporting

confidence: 91%

Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy

Rupp

Winkler

Lutz

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…Perioperative radiological variables that can affect LHF were measured according to previously reported methods. 4,9,[12][13][14]21,32 These variables were divided into 2 categories: unmodifiable and modifiable. Unmodifiable factors include the specific geometric data and inevitable osteotomy configurations of patients, such as the degree of correction.…”

Section: Factors Contributing To Lhf Developmentmentioning

confidence: 99%

“…Modifiable factors include osteotomy configurations that can be intraoperatively controlled by the surgeon (Figure 4). Accordingly, the unmodifiable factors were as follows: the lateral tibial width (LCW), 9 the lateral condylar slope (LCS), 9 the lateral condylar length (LCL), the fibular height (FH), 9 the anterior osteotomy gap, 12 the posterior osteotomy gap (PG), 4,12,13 and the distance X. 32 For LCW and LCS measurements, 2 lines were drawn according to the methods in a previous study.…”

Section: Factors Contributing To Lhf Developmentmentioning

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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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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“…Through the improvement of stability, scheduled weight‐bearing (8–12 weeks) was achieved and loss of correction was prevented. Fracture of the lateral cortical hinge has been reported to occur in 16% to 25% of patients after medial opening wedge high tibial osteotomy, which is recognized as a risk factor of prolonged bone healing time and nonunion. Practically, it is unlikely for hinge fracture to be completely avoided, especially if there is an incidence of latent hinge disruption.…”

Section: Discussionmentioning

confidence: 99%

Medial Open‐wedge Osteotomy with Double‐plate Fixation for Varus Malunion of the Distal Femur

Wang

Sun

et al. 2019

Orthopaedic Surgery

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Objective To present our clinical experience of treating varus malunion of the distal femur through a medial open‐wedge osteotomy with double‐plate fixation. Methods A prospective cohort study was performed. From January 2005 to February 2015, 15 consecutive patients with varus malunion following distal femur fractures were surgically treated at a single level I trauma center. The coronal and sagittal deformity were corrected by a medial open‐wedge osteotomy of the distal femur. A medial buttress plate was used to maintain the realignment. A lateral locking plate was additionally used as a protection plate. The mean age of patients at the time of the surgery was 35.5 years (range, 22–58 years). The radiographical evaluation included the mechanical femorotibial angle, the mechanical lateral distal femoral angle, the anatomic posterior distal femoral angle, and the leg length discrepancy. Clinical outcome evaluation consisted of the range of motion (ROM) and Hospital for Special Surgery (HSS) score. Results Mean follow‐up was 7.4 years (range, 4–11.5 years). Varus and flexion malalignment and limb discrepancy were adequately corrected in all patients. The mechanical femorotibial angle, the mechanical lateral distal femoral angle, and the anatomic posterior distal femoral angle were restored from 17.5° (range, 13°–25°) to 2.3° (range, − 2°–7°), 102.3° (range, 95°–112°) to 85.2° (range, 81°–92°), and 77.1° (range, 65°–87°) to 82.7° (range, 76°–88°), respectively. The leg length discrepancy was diminished from 3.4 cm (range, 2.4–4.5 cm) to 0.8 cm (range, 0–1.7 cm). The average bone healing time was 4.1 months (range, 2.5–6 months). The average ROM of the affected knees at 24‐month follow‐up was 3.4°–112.55°. The score of HSS at 4‐years follow‐up was 76.1 (range, 64–88). No internal fixation failure or secondary operation was noted until the last follow‐up. Conclusion Medial open‐wedge osteotomy can adequately correct the posttraumatic varus malunion of the distal femur. With fixation of the double plate, non‐displaced bone healing and good functional outcome are expected.

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Predictive Factors for and Detection of Lateral Hinge Fractures Following Open Wedge High Tibial Osteotomy: Plain Radiography Versus Computed Tomography

Cited by 43 publications

References 30 publications

Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy

Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy

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

Medial Open‐wedge Osteotomy with Double‐plate Fixation for Varus Malunion of the Distal Femur

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