Incidence and Predictors of Lateral Hinge Fractures Following Medial Opening-Wedge High Tibial Osteotomy Using Locking Plate System: Better Performance of Computed Tomography Scans

Han, Seung-Beom; Choi, Jaehyuk; Mahajan, Atul; Shin, Yang Sik

doi:10.1016/j.arth.2019.01.026

Cited by 24 publications

(33 citation statements)

References 22 publications

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“…Type I LHFs have been reported to be relatively stable and have the benefit of enhanced fracture healing. 4,28 In contrast, a study reported that type I LHFs were associated with the most significant correction loss in terms of coronal alignment. 12 In this study, type I LHFs showed correction loss (varus recurrence) by slight slippage and compression of the lateral hinge area between 2 weeks and 1 year after surgery (Figure 7).…”

Section: Discussionmentioning

confidence: 95%

“…In addition, the change patterns of the WBL ratio provide the basic information necessary to exercise specific caution and establish the rehabilitation protocol required for each LHF type. Previous studies have reported various predictive factors that affect the occurrence of LHFs, including the osteotomy gap height, 4,12,21 fibular position, 9 lateral proximal tibial geometry, 9 coronal osteotomy slope, 12 and retrotubercular osteotomy configurations (thickness, angle, and gap distance). 6 In addition, Ogawa et al 25 reported on the importance of the sufficiency of the osteotomy, the angle between the direction of insertion of the wedge (gap opening direction) and the line of the hinge, and the level of the end point of the osteotomy.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Factors Contributing To Lhf Developmentmentioning

confidence: 99%

Section: Factors Contributing To Lhf Developmentmentioning

confidence: 99%

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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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“… 7 , 26 , 38 , 40 In addition, various factors affecting LHF, such as fibular position, osteotomy gap height, and wedge-hinge relationship, have been introduced. 6 , 15 , 26 , 29 However, data regarding the predictors of LHF are lacking.…”

mentioning

confidence: 99%

Incidence and Factors Affecting the Occurrence of Lateral Hinge Fracture After Medial Opening-Wedge High Tibial Osteotomy

Lee

Kim

Baek

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Few clinical studies have reported the predictors of lateral hinge fracture (LHF) after medial opening-wedge high tibial osteotomy (MOWHTO). Purpose/Hypothesis: The purpose was to compare the incidence of LHF on plain radiographs versus computed tomography (CT) scans and to investigate the factors related to the development of LHF after MOWHTO. We hypothesized that (1) a higher LHF detection rate would be seen on CT scans versus plain radiographs and (2) LHF incidence would be related to opening gap width and hinge position. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 97 MOWHTO cases were included. The presence and types of LHF were determined from plain radiographs and CT scans. Radiographic parameters were measured on plain radiographs taken 6 weeks postoperatively. Anterior and posterior opening gap widths, coronal and sagittal osteotomy slopes, and fibular height were calculated from CT scans. The wedge-hinge relationship and the zone of hinge position were assessed, and the patient and radiographic factors related to LHF occurrence were evaluated. Results: Seventeen LHF cases (20.5%) were detected on plain radiographs, while significantly more (37 cases; 44.6%) were found on CT scans ( P = .001). Based on Takeuchi classification, 28 LHF cases were considered type 1, 7 were type 2, and 2 were type 3. Logistic regression analysis revealed that opening gap width (odds ratio, 1.615; 95% confidence interval, 1.232-2.118; P = .001) and posterior opening gap width (odds ratio, 3.731; 95% confidence interval, 1.642-4.351; P = .008,) differed significantly between patients with versus without LHF. Other patient and radiographic factors were not significantly related to LHF occurrence. Receiver operating characteristic curve analysis identified the opening gap width cutoff values for LHF as 11.0 mm (area under the curve, 0.81; sensitivity, 78.4%; specificity, 73.9%). Conclusion: The incidence of LHF after MOWHTO can be underestimated on plain radiographs compared with CT scans. Only large opening gap width, especially posterior gap width, was found to have a statistically significant relationship with occurrence of LHF. Therefore, special caution for possible LHF may be needed if a large correction is planned.

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Seil¹,

Mouton²,

Schuster³

et al. 2019

Arthroskopie

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Incidence and Predictors of Lateral Hinge Fractures Following Medial Opening-Wedge High Tibial Osteotomy Using Locking Plate System: Better Performance of Computed Tomography Scans

Cited by 24 publications

References 22 publications

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

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

Incidence and Factors Affecting the Occurrence of Lateral Hinge Fracture After Medial Opening-Wedge High Tibial Osteotomy

Lösungen für häufige Komplikationen bei Beinachsenkorrekturen

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