Which is the best fixation method for lateral cortex disruption in the medial open wedge high tibial osteotomy? A biomechanical study

Kazımoğlu, Cemal; Akdoğan, Yaşar; Şener, Muhittin; Kurtulmuş, Ahmet; Karapınar, Hasan; Uzun, Bora

doi:10.1016/j.knee.2008.04.004

Cited by 34 publications

(28 citation statements)

References 11 publications

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“…This was supported by the results of a biomechanical study in which the wedge micromotions of 1-leg plate systems were significantly greater than those of 2-leg plate systems, with bone-screw loosening and construct instability. [21]…”

Section: Discussionmentioning

confidence: 99%

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

Nha

Jung²,

Koh

et al. 2019

Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

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

Nha

Jung²,

Koh

et al. 2019

Medicine

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“…For the one-leg systems, the wedge micromotions were significantly higher that the counterparts and were contributed to the bone-screw loosening and construct instability [2,35]. At the wedge tip (edge aa ) of the one-leg systems, Figure 6 showed the occurrence of bone separation that results from the leverage effect and negatively affects the callus formation [36].…”

Section: Discussionmentioning

confidence: 99%

Stress and stability comparison between different systems for high tibial osteotomies

Luo

Hua

Lin

et al. 2013

BMC Musculoskelet Disord

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BackgroundHigh tibial osteotomy (HTO) with a medial opening wedge has been used to treat medial compartment osteoarthritis. However, this makes the proximal tibia a highly unstable structure and causes plate and screws to be the potentials sources for mechanical failure. Consequently, proper design and use of the fixation device are essential to the HTO especially for overweight or full weight-bearing patients.MethodsBased on the CT-based images, a tibial finite-element model with medial opening was simulated and instrumented with one-leg and two-leg plate systems. The construct was subjected to physiological and surgical loads. Construct stresses and wedge micromotions were chosen as the comparison indices.ResultsThe use of locking screws can stabilize the construct and decrease the implant and bone stresses. Comparatively, the two-leg design provides a wider load-sharing base to form a force-couple mechanism that effectively reduces construct stresses and wedge micromotions. However, the incision size, muscular stripping, and structural rigidity are the major concerns of using the two-leg systems. The one-leg plates behave as the fulcrum of the leverage system and make the wedge tip the zone of tension and thus have been reported to negatively affect the callus formation.ConclusionsThe choice of the HTO plates involved the trade-off between surgical convenience, construct stability, and stress-shielding effect. If the stability of the medial opening is the major concern, the two-leg system is suggested for the patients with heavy load demands and greater proximal tibial size. The one-leg system with locking screws can be used for the majority of the patients without heavy bodyweight and poor bone quality.

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“…An axial force of 2500 N with a distribution of 60 % to the medial compartment was applied to simulate the axial compressive load on an adult knee during single-limb stance [ 8 , 11 ]. For both the plate-screw and screw fixation systems, it was assumed that the implants and bones were in direct contact with a frictional coefficient of 0.3 [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

Stress and stability of plate-screw fixation and screw fixation in the treatment of Schatzker type IV medial tibial plateau fracture: a comparative finite element study

Huang

Zhi

et al. 2015

J Orthop Surg Res

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PurposeThe purpose of this study is to compare the stress and stability of plate-screw fixation and screw fixation in the treatment of Schatzker type IV medial tibial plateau fracture.MethodsA three-dimensional (3D) finite element model of the medial tibial plateau fracture (Schatzker type IV fracture) was created. An axial force of 2500 N with a distribution of 60 % to the medial compartment was applied to simulate the axial compressive load on an adult knee during single-limb stance. The equivalent von Mises stress, displacement of the model relative to the distal tibia, and displacement of the implants were used as the output measures.ResultsThe mean stress value of the plate-screw fixation system was 18.78 MPa, which was significantly (P < 0.001) smaller than that of the screw fixation system. The maximal value of displacement (sum) in the plate-screw fixation system was 2.46 mm, which was lower than that in the screw fixation system (3.91 mm). The peak stress value of the triangular fragment in the plate-screw fixation system model was 42.04 MPa, which was higher than that in the screw fixation model (24.18 MPa). But the mean stress of the triangular fractured fragment in the screw fixation model was significantly higher in terms of equivalent von Mises stress (EVMS), x-axis, and z-axis (P < 0.001).ConclusionsThis study demonstrated that the load transmission mechanism between plate-screw fixation system and screw fixation system was different and the stability provided by the plate-screw fixation system was superior to the screw fixation system.

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Which is the best fixation method for lateral cortex disruption in the medial open wedge high tibial osteotomy? A biomechanical study

Cited by 34 publications

References 11 publications

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

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

Stress and stability comparison between different systems for high tibial osteotomies

Stress and stability of plate-screw fixation and screw fixation in the treatment of Schatzker type IV medial tibial plateau fracture: a comparative finite element study

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