Biomechanical Analysis of a Novel Wedge Locking Plate in a Porcine Tibial Model

Ha, Jeong Ku; Yeom, Chul Hyun; Jang, Ho Su; Song, Han Eui; Lee, Sung Jae; Kim, Kang Hee; Chung, Kyu Sung; Bhat, Mahendar Gururaj; Kim, Jin Goo

doi:10.4055/cios.2016.8.4.373

Cited by 11 publications

(7 citation statements)

References 15 publications

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“…Therefore, CT is a more accurate method for detecting hinge fractures and will be useful for deciding the postoperative rehabilitation protocol after corrective osteotomy around the knee. In contrast to studies on high tibial osteotomy, 7,8,11,22 a few clinical studies investigated the factors that affect bone healing after distal femoral osteotomy. A recent clinical study demonstrated that a biplanar osteotomy technique shortens the bone healing time.…”

Section: Discussionmentioning

confidence: 99%

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Detection of Lateral Hinge Fractures After Medial Closing Wedge Distal Femoral Osteotomy: Computed Tomography Versus Plain Radiography

et al. 2021

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Background: Limited evidence exists in the literature regarding the detection rates of lateral hinge fracture (LHF) on computed tomography (CT) after medial closing wedge distal femoral osteotomy (MCDFO). Moreover, the effect of LHF on bone healing after MCDFO remains unclear. Hypothesis: The detection rates of LHF after MCDFO would be higher on CT than on plain radiography. The incidence of problematic bone healing would be higher in the knees with LHF than in those without LHF. Study Design: Cohort study (diagnosis), Level of evidence, 3. Methods: Patients who underwent MCDFO between May 2009 and July 2019 were retrospectively evaluated. The presence of LHF was evaluated using immediate postoperative plain radiography and CT. The detection rates of LHF on plain radiography and CT were compared. The incidence of problematic bone healing (nonunion, delayed union, and loss of correction) was also compared between the knees with LHF and those without LHF. Results: A total of 55 knees of 43 patients (mean age, 37.7 ± 16.7 years) were included in the study. Although 33 LHFs were detected on CT, only 19 LHFs were detected on plain radiography. The detection rate of LHF was significantly higher on CT than on plain radiography (60% vs 34.5%; P = .008). At 1-year follow-up, 10 cases of problematic bone healing (1 nonunion, 4 delayed unions, and 5 losses of correction) were identified. The incidence of problematic bone healing was significantly higher in the knees with LHF than in those without LHF as shown on plain radiography (36.8% vs 8.3%; P = .001) and CT (30.3% vs 0%; P = .004). Conclusion: LHF can be detected better on CT than on plain radiography and has a negative effect on bone healing after MCDFO. For patients with LHF detected on either plain radiography or CT, careful rehabilitation with close follow-up is recommended.

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Section: Discussionmentioning

confidence: 99%

“…In contrast to studies on high tibial osteotomy, 7,8,11,22 a few clinical studies investigated the factors that affect bone healing after distal femoral osteotomy. A recent clinical study demonstrated that a biplanar osteotomy technique shortens the bone healing time.…”

Section: Discussionmentioning

confidence: 99%

Detection of Lateral Hinge Fractures After Medial Closing Wedge Distal Femoral Osteotomy: Computed Tomography Versus Plain Radiography

et al. 2021

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“…High tibial osteotomy (HTO) is an effective treatment method to manage young patients with varus deformity paired with osteoarthritis (OA) of the medial compartment. [1][2][3] In this context, the weight-bearing axis can be shifted laterally after surgery and, as a result, the unloading of the medial compartment could mitigate the medial OA. [4][5][6] However, valgus alignment after HTO reversely increases the loading of the lateral compartment, potentially provoking the degeneration of the lateral compartment to progress.…”

Section: Introductionmentioning

confidence: 99%

Open-wedge high tibial osteotomy in patients with discoid lateral meniscus

Kim

Shin

Lee

et al. 2021

J Orthop Surg (Hong Kong)

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Background: There are concerns about the progression of the lateral osteoarthritis (OA) should be taken into account when high tibial osteotomy (HTO) is performed in patients with discoid lateral meniscus (LM). This study evaluated the clinical results of HTO in patients with discoid LM and elucidated factors affecting the results. Methods: This study evaluated 32 female patients with varus deformity and medial OA. Patients with discoid LM (8 patients) or without discoid LM (24 patients) underwent open-wedge HTO. The mean age was 53.5 years and the mean follow-up period was 35 months. Clinical results, including the Hospital for Special Surgery (HSS) score, Knee Society knee score (KS) and function score (FS), were evaluated. The progression of OA in the lateral compartment was also evaluated. Finally, we evaluated the factors affecting the clinical results and OA progression in the lateral compartment. Results: Between two groups, all clinical scores were not different (p = 0.964, 0.963, and 0.559, respectively). Three of eight patients (37.5%) in the discoid group developed OA in the lateral compartment, whereas 2 of 24 patients (8.3%) in the control group developed such; however, this was not significantly different (p = 0.085). In discoid group, patients with undercorrection has higher KS relative to patients with acceptable correction (p = 0.044). Other clinical results and OA change in the lateral compartment were not affected by evaluated factors. Conclusions: Patients who underwent open-wedge HTO showed the satisfactory clinical results and lateral OA progression regardless of the presence or absence discoid LM. However, when discoid LM was present, patients with undercorrection showed higher KS in comparison with patients with acceptable correction.

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“…To maintain the corrected alignment after HTO, the use of locking plate and screws helps to establish a strong support for the osteotomied tibia till bone union [7–9]. In current practice of HTO, traditional titanium locking plate and screw fixation yields acceptable outcomes, and approximately 90% of the patients who returned to work or sport did so within 1 year [6].…”

Section: Introductionmentioning

confidence: 99%

“…To obtain better results, further studies focused either on the structural stability established between the bone and plate or on the creation of beneficial biomechanical stimuli from interfragmentary movement via flexible/dynamic fixation were made in the past [11–13]. In these biomechanical studies, some issues including the geometry and configuration of plate, the use of wedge spacer, and even the interfragmentary movement promoting callus formation during bony healing [7, 11, 14–16] were investigated. However, to our note, a more fundamental factor, the screw, was less mentioned and rarely investigated.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical investigation of the type and configuration of screws used in high tibial osteotomy with titanium locking plate and screw fixation

Chen

Chang

et al. 2019

J Orthop Surg Res

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BackgroundTo maintain the corrected alignment after high tibial osteotomy (HTO), fixation with titanium locking plate and screws is widely used in current practice; however, screw breakage is a common complication. Thus, this study was to investigate the mechanical stability of HTO with locking plate and various screw fixations, including the length as well as the type.MethodsA finite element (FE) model involving a distal femur, meniscus, and a proximal tibia with HTO fixed with a titanium locking plate and screws was created. The angle of the medial open wedge was 12°, and bone graft was not used. Two types of screws, namely conventional locking and far-cortical locking screws, with various lengths and configurations were used. At the proximal tibia, conventional locking screws with different lengths, 30 and 55 mm, were used; at the tibia shaft, different screw fixations including one-cortical, two-cortical, and far-cortical locking screws were used.ResultsThe use of far-cortical locking screw generated the highest equivalent stress on the screws, which was four times (from 137.3 to 541 MPa) higher than that of the one-cortical screw. Also, it led to the maximum deformation of the tibia and a greater gap deformation at the osteotomy site, which was twice (from 0.222 to 0.442 mm) larger than that of the one-cortical screw. The effect of different locking screw length on tibia deformation and implant stress was minor.ConclusionThus, far-cortical locking screws and plates increase interfragmentary movement but the screw stress is relatively high. Increasing the protection time (partial weight duration) is suggested to decrease the risk of screw breakage in HTO through fixation with titanium far-cortical locking screws and plates.

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Biomechanical Analysis of a Novel Wedge Locking Plate in a Porcine Tibial Model

Cited by 11 publications

References 15 publications

Detection of Lateral Hinge Fractures After Medial Closing Wedge Distal Femoral Osteotomy: Computed Tomography Versus Plain Radiography

Detection of Lateral Hinge Fractures After Medial Closing Wedge Distal Femoral Osteotomy: Computed Tomography Versus Plain Radiography

Open-wedge high tibial osteotomy in patients with discoid lateral meniscus

Biomechanical investigation of the type and configuration of screws used in high tibial osteotomy with titanium locking plate and screw fixation

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