D-hole breakage of 2 angular stable locking plates for medial opening-wedge high tibial osteotomy

Abstract

An adequate stable fixation implant should be used for medial opening-wedge high tibial osteotomy (MOWHTO) to promote rapid bone healing without complications. To date, the highest fixation stability has been observed for angular stable locking plates. However, there is still little medical literature regarding breakage of these plates. The purpose of the present study was to report the results of plate breakage around D-hole with the use of both types of locking plate fixation for MOWHTO.Medical records of 12 patients who experienced plate breakage after MOWHTO with either a TomoFix or OhtoFix plate between August 2013 and August 2016 were retrospectively reviewed.A total of 12 patients (7 males and 5 females) who experienced plate breakage at the screw hole just above the osteotomy were evaluated (age, 63 ± 8 years; body mass index (BMI), 28 ± 2 kg/m2; opening gap height, 12 ± 2 mm). There were 9 patients (75%) with plate breakage and loss of correction necessitating revision surgery, and 11 patients (92%) had lateral cortical hinge fractures postoperatively. Of the 9 patients with loss of correction necessitating revision surgery, 4 had a TomoFix plate and 5 had an OhtoFix plate. The only statistically significant association with broken plates lost reduction was the presence of lateral cortical hinge fractures (P = .003), but there was no significant association with age, gender, BMI, diabetes, smoking, plate type, opening gap height, and material used to fill the wedge. In addition, mean knee society score in the 12 patients was significantly higher postoperatively than preoperatively (P < .001).Since the amount of plate breakage was just over 1% and with only 12 in total, no true conclusion can be made with certainty. However, in the face of no lateral hinge or cortical disruption, there is a 99% success rate with the plate described. If the lateral hinge is disrupted, a restriction of activity or weight bearing may be needed.

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

“…Plate breakage near the D-hole was highly related to LHFs in a previous study [ 14 ], and the result was in accordance with the present FE results. 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 such a situation, placing a lateral plate directly at the fractured lateral hinge could efficiently stabilize the tibia with HTO and LHFs. Plate breakage near the D-hole was highly related to LHFs in a previous study [14], and the result was in accordance with the present FE results. A relative highstress area appeared near the outside corner and the Dhole of the medial TomoFix plate in HTO, particularly with LHFs in the present study.…”

“…Other studies have reported an LHF incidence of 19.8–41.2% after HTO [ 7 , 11 – 13 ]. Furthermore, LHF is highly related to nonunion and plate breakage [ 14 ].…”

Monocortical fixation for locking plate distal screws does not impair mechanical properties in open-wedge high tibial osteotomy

“…Lateral hinge fracture is a common postoperative complication of OWHTO [ 11 ] and has been reported to cause nonunion or loss of correction due to its unstable features [ 1 , 19 ]. Nha et al reported that plate breakage was associated with the presence of lateral cortical hinge fracture [ 20 ]. Furthermore, lateral hinge fracture is sometimes overlooked during surgery [ 21 ].…”

“…Floerkemeier et al reported favourable mid-term results with the use of TomoFix without artificial bone [ 23 ]. In contrast, Nha et al reported that artificial bone was inserted to minimise postoperative loss of correction when the osteotomy gap was more than 12 mm [ 20 ]. Takeuchi et al reported that they had prepared several artificial bones with heights of 7.5, 10, 12.5, and 15 mm to insert at the osteotomy site [ 8 ].…”