Varization open-wedge osteotomy of the distal femur: comparison between locking plate and angle blade plate constructs

Batista, Bruno Bellaguarda; Volpon, José Batista; Shimano, Antonio Carlos; Kfuri, Maurício

doi:10.1007/s00167-014-2998-1

Cited by 10 publications

(17 citation statements)

References 22 publications

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“…This is in accordance with an overall incidence of 46% of medial cortical hinge fractures in LOW-DFOs in the present study. Non-unions of the osteotomy gap are dreaded complications of LOW-DFO [ 2 , 3 , 6 , 14 , 20 , 30 ] and may be attributed to medial cortical hinge fractures and the associated reduced axial and torsional stiffness as well as the increased rotational movement across the osteotomy gap for the bone-implant construct [ 1 , 29 ]. However, despite the high incidence of hinge fractures in the present study, the complication rate was only 5% and showed no difference between patients with and without a medial cortical hinge fracture.…”

Section: Discussionmentioning

confidence: 99%

“…The most commonly reported drawbacks include a high rate of reoperations and a considerable number of delayed and non-unions of the osteotomy gap [ 2 , 3 , 6 , 14 , 20 , 30 ]. One reason for non-unions could be a fracture of the medial cortical hinge and the associated reduced axial and torsional stiffness as well as the increased rotational movement across the osteotomy gap for the bone-implant construct [ 1 , 29 ]. Therefore, fractures of the medial cortical hinge should be avoided.…”

Section: Introductionmentioning

confidence: 99%

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A hinge position distal to the adductor tubercle minimizes the risk of hinge fractures in lateral open wedge distal femoral osteotomy

Winkler

Rupp

Lutz

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the incidence and morphology of medial cortical hinge fractures in lateral open wedge distal femoral osteotomy (LOW-DFO) and to determine a safe zone for the position of the osteotomy hinge to minimize the risk of hinge fractures. Methods Consecutive patients who underwent LOW-DFO for symptomatic valgus malalignment were screened for eligibility for this retrospective observational cohort study. Demographical and surgical data were collected. The incidence and morphology of medial cortical hinge fractures were evaluated on standard postoperative anterior–posterior knee radiographs. Comprehensive measurements evaluating the osteotomy gap and the position of the osteotomy hinge were taken. Additionally, each osteotomy hinge was assigned to a corresponding sector of a proposed five-sector grid of the distal medial femur. Results A total of 100 patients (60% female) with a mean age of 31 ± 13 years were included. The overall incidence of medial cortical hinge fractures was 46% and three distinct fracture types were identified. The most frequently observed fracture type was extension of the osteotomy gap (76%), followed by a proximal (20%) and distal (4%) course of the fracture line in relation to the hinge. Group comparison (hinge fracture vs. no hinge fracture) showed statistically significant higher values for the height of the osteotomy gap (p = 0.001), the wedge angle (p = 0.036), and the vertical distance between the hinge and the proximal margin of the adductor tubercle (AT; p = 0.002) in the hinge fracture group. Furthermore, a significantly lower horizontal distance between the hinge and the medial cortical bone (p = 0.036) was observed in the hinge fracture group. A statistically significant higher incidence of medial cortical hinge fractures was observed when the position of the osteotomy hinge was proximal compared to distal to the proximal margin of the AT (53% vs. 27%; p = 0.023). Conclusion Medial cortical hinge fractures in LOW-DFO are a common finding with three distinct fracture types. To minimize the risk of medial cortical hinge fractures, it is recommended to aim for a position of the osteotomy hinge at the level of or distal to the proximal margin of the adductor tubercle. Level of evidence Prognostic study; Level III

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A hinge position distal to the adductor tubercle minimizes the risk of hinge fractures in lateral open wedge distal femoral osteotomy

Winkler

Rupp

Lutz

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“…While the favourable postoperative outcomes reported in the literature have increased the popularity of the femoral lateral closing (CW) wedge technique [ 2 , 15 , 25 , 35 , 43 , 44 ], recent investigations are aimed to identify reasons for failures [ 13 ]. Hinge fractures in distal femoral osteotomies (DFO)—resulting in increased rotational movement across the osteotomy plane [ 3 , 41 ]—may explain a considerable number of delayed unions or losses of correction reported [ 4 , 6 , 8 , 9 , 14 , 25 , 54 ]. While technical factors and vulnerable anatomical zones associated with an increased risk of hinge fractures have been reported for HTO [ 16 , 31 – 33 , 49 ], medial closing wedge (MCW) DFO [ 21 , 39 ] and LOW-DFO [ 53 ], the only report investigating hinge fractures in LCW-DFO to-date was performed in a relatively small collective and could not identify any risk factors [ 36 ].…”

Section: Introductionmentioning

confidence: 99%

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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“…Loading regimes include compression, 35 – 37 , 46 – 59 bending (three or four point) 36 , 47 , 52 , 54 , 57 , 59 – 62 and torsion testing, 36 , 48 , 49 , 54 , 60 , 62 while most of them are conducted as a combination of compression, bending and torsion to mimic the real load condition of the bones. The end of test criteria are;…”

Section: Experimental Testing Of Fracture Fixation Platesmentioning

confidence: 99%

“…(1) Until failure, where the load is applied at a fixed speed of load control or movement control, for example, 26 N/min, 53 300 N/s, 55 3 mm/min, 5°/min 57 or cyclic loading conditions. 53 This is widely adopted as an overall evaluation of the construct, including stress, interfragmentary movement, stiffness, yield load, ultimate load, failure mode and fatigue strength.…”

Section: Experimental Testing Of Fracture Fixation Platesmentioning

confidence: 99%

Experimental testing of fracture fixation plates: A review

Zhang

Patel²,

Brady³

et al. 2022

Proc Inst Mech Eng H

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Metal and its alloys have been predominantly used in fracture fixation for centuries, but new materials such as composites and polymers have begun to see clinical use for fracture fixation during the past couple of decades. Along with the emerging of new materials, tribological issues, especially debris, have become a growing concern for fracture fixation plates. This article for the first time systematically reviews the most recent biomechanical research, with a focus on experimental testing, of those plates within ScienceDirect and PubMed databases. Based on the search criteria, a total of 5449 papers were retrieved, which were then further filtered to exclude nonrelevant, duplicate or non-accessible full article papers. In the end, a total of 83 papers were reviewed. In experimental testing plates, screws and simulated bones or cadaver bones are employed to build a fixation construct in order to test the strength and stability of different plate and screw configurations. The test set-up conditions and conclusions are well documented and summarised here, including fracture gap size, types of bones deployed, as well as the applied load, test speed and test ending criteria. However, research on long term plate usage was very limited. It is also discovered that there is very limited experimental research around the tribological behaviour particularly on the debris’ generation, collection and characterisation. In addition, there is no identified standard studying debris of fracture fixation plate. Therefore, the authors suggested the generation of a suite of tribological testing standards on fracture fixation plate and screws in the aim to answer key questions around the debris from fracture fixation plate of new materials or new design and ultimately to provide an insight on how to reduce the risks of debris-related osteolysis, inflammation and aseptic loosening.

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Varization open-wedge osteotomy of the distal femur: comparison between locking plate and angle blade plate constructs

Cited by 10 publications

References 22 publications

A hinge position distal to the adductor tubercle minimizes the risk of hinge fractures in lateral open wedge distal femoral osteotomy

A hinge position distal to the adductor tubercle minimizes the risk of hinge fractures in lateral open wedge distal femoral osteotomy

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

Experimental testing of fracture fixation plates: A review

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