Top

European Journal of Orthopaedic Surgery & Traumatology

Published in:

01-02-2020 | Pseudarthrosis | Original Article • KNEE - FRACTURES

Opposite hinge fractures in high tibial osteotomy: a displacement subtype is more critical than a fracture type

Authors: Anton Dorofeev, Alfred Tylla, Martin Benco, Wolf Drescher, Richard Stangl

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 2/2020

Abstract

Purpose

Analysis of the structure of the fractures of opposite hinge (FOH) after angle-stable closed-wedge (CW) and open-wedge (OW) high tibial osteotomy (HTO), and their influence on the development of tibial pseudarthrosis.

Methods

187 CW and 94 OWHTOs were analyzed retrospectively. The FOHs in the OWHTO were classified according to Takeuchi, and in the CWHTO—according to the own classification with two types (depending on the direction of FOH). FOHs in both techniques were also subdivided into three subtypes according to displacement (A—non-displaced, B—primarily displaced, C—secondarily displaced). The statistical analysis included correlation analysis and logistic regression.

Results

FOHs were found in 81 (43.3%) CW and 39 (41.2%) OWHTOs. The stable type 1 fractures predominated in OWHTO (76.9 vs. 42%, p < 0.001), the unstable type 2 FOHs prevailed in CWHTO (58 vs. 17.9%, p < 0.001). The tibial pseudarthrosis rate was higher with type 1 (20 vs. 12.9%, n.s.) and subtype A (16.7 vs. 6.8%, p = 0.048) FOHs in OWHTO, and with type 2 (20 vs. 0%, p < 0.001) and subtypes B (25 vs. 0%, p < 0.001) and C (29.4 vs. 25%, n.s.) in CWHTO (without FOHs 0.9% in CW and 1.8% in OWHTO, n.s.). Relevant correlations were detected between the pseudarthrosis rate and fracture type only in CWHTO (ρ_s = 0.298, p < 0.001, OR 24.87 for type 2) and displacement subtype in both groups (for subtype C: ρ_s = 0.345, p < 0.001, OR 43.75 and ρ_s = 0.231, p = 0.02, OR 18.0, respectively).

Conclusions

The unstable FOH types were more common in CWHTO. The displacement subtype was more predictive for the development of tibial pseudarthrosis than the fracture type, especially in OWHTO. The secondarily displaced FOHs (subtype C) represented the highest risk for the occurrence of pseudarthrosis in both techniques.

Gstottner M, Pedross F, Leidensteiner M, Bach C (2008) Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg 128:111–115CrossRef

Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br 90(5):592–596CrossRef

Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34(2):155–160CrossRef

Schallbereger A, Jacobi M, Wahl P, Maestretti G, Jakob RP (2011) High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13-21 years. Knee Surg Sports Traumatol Arthrosc 19:122–127CrossRef

Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia—early results in 92 cases. Injury 34(Suppl 2):B55–B62CrossRef

van Raaij TM, Brouwer RW, de Vlieger R, Reijman M, Verhaar JA (2008) Opposite cortical fracture in high tibial osteotomy: lateral closing compared to the medial opening-wedge technique. Acta Orthop 79(4):508–514CrossRef

Weng PW, Chen CH, Luo CA, Sun JS, Tsuang YH, Cheng CK, Lin SC (2017) The effects of tibia profile, distraction angle, and knee load on wedge instability and hinge fracture: a finite element study. Med Eng Phys 42:48–54. https://doi.org/10.1016/j.medengphy.2017.01.007 CrossRefPubMed

Kessler OC, Jacob HA, Romero J (2002) Avoidance of medial cortical fracture in high tibial osteotomy: improved technique. Clin Orthop Relat Res 395:180–185CrossRef

Meidinger G, Imhoff AB, Paul J, Kirchhoff C, Sauerschnig M, Hinterwimmer S (2011) May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union. Knee Surg Sports Traumatol Arthrosc 19(3):333–339CrossRef

10.

Miller BS, Dorsey WO, Bryant CR, Austin JC (2005) The effect of lateral cortex disruption and repair on the stability of the medial opening wedge high tibial osteotomy. Am J Sports Med 33(10):1552–1557CrossRef

11.

Tunggal AW, Higgins GA, Waddel JP (2010) Complications of closing wedge high tibial osteotomy. Int Orthop 34(2):255–261CrossRef

12.

Ogawa H, Matsumoto K, Akiyama H (2017) The prevention of a lateral hinge fracture as a complication of a medial opening wedge high tibial osteotomy: a case control study. Bone Joint J 99(7):887–893CrossRef

13.

Han SB, Lee DH, Shetty GM, Hae DJ, Song JG, Nha KW (2013) A “safe zone” in medial open-wedge high tibia osteotomy to prevent lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc 21:90–95CrossRef

14.

Nelissen EM, van Langelaan EJ, Nelissen RG (2010) Stability of medial opening wedge high tibial osteotomy: a failure analysis. Int Orthop 34(2):217–223CrossRef

15.

Spahn G (2004) Complications in high tibial (medial opening wedge) osteotomy (2004). Arch Orthop Trauma Surg 124(10):649–653CrossRef

16.

Bae DK, Park CH, Kim EJ, Song SJ (2016) Medial cortical fractures in computer-assisted closing-wedge high tibial osteotomy. Knee 23(2):295–299CrossRef

17.

Nakamura R, Komatsu N, Fujita K, Kuroda K, Takahashi M, Omi R et al (2017) Appropriate hinge position for prevention of unstable lateral hinge fracture in open wedge high tibial osteotomy. Bone Joint J 99(10):1313–1318CrossRef

18.

Pape D, Adam F, Rupp S, Seil R, Kohn D (2004) Stability, bone healing and loss of correction after valgus realignment oft he tibial head. A roentgen stereometry analysis. Orthopade 33(2):208–217CrossRef

19.

Rossi R, Bonasia DE, Amendola A (2011) The role of high tibial osteotomy in the varus knee. J Am Acad Orthop Surg 19:590–599CrossRef

20.

Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 10:585–608PubMed

21.

Lee DC, Byun SJ (2012) High tibial osteotomy. Knee Surg Relat Res 24(2):61–69CrossRef

22.

Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y et al (2012) Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy 28(1):85–94CrossRef

23.

Dorofeev A, Tylla A, Drescher W, Stangl R (2019) Opposite cortical fractures in closed-wedge HTO: New classification and treatment algorithm. The Knee. https://doi.org/10.1016/j.knee.2019.07.014 CrossRefPubMed

24.

Atrey A, Morison Z, Tosounidis T, Tunggal J, Waddell JP (2012) Complications of closing wedge high tibial osteotomies for unicompartmental osteoarthritis of the knee. Bone Joint Res 1(9):205–209CrossRef

25.

Reyle G, Lorbach O, Diffo Kaze A, Hoffmann A, Pape D (2017) Prevention of lateral cortex fractures in open wedge high tibial osteotomies. The anteroposterior drill hole approach. Orthopade 46(7):610–616CrossRef

26.

Lee YS, Won JS, Oh WS, Park HG, Lee BK (2014) Lateral tibial bone mineral density around the level of the proximal tibiofibular joint. Knee Surg Sports Traumatol Arthrosc 22(7):1678–1683CrossRef

27.

Dexel J, Fritzsche H, Beyer F, Harman MK, Lützner J (2017) Open-wedge high tibial osteotomy: incidence of lateral cortex fractures and influence of fixation device on osteotomy healing. Knee Surg Sports Traumatol Arthrosc 25(3):832–837CrossRef

28.

van Houten AH, Heesterbeek PJ, van Heerwaarden RJ, van Tienen TG, Wymenga AB (2014) Medial open wedge high tibial osteotomy: can delayed or nonunion be predicted? Clin Orthop Relat Res 472(4):1217–1223CrossRef

29.

Böhler M, Fuss FK, Schachinger W, Wölfl G, Knahr K (1999) Loss of correction after lateral closing wedge high tibial osteotomy—a human cadaver study. Arch Orthop Trauma Surg 119(3–4):232–235PubMed

30.

Jacobi M, Wahl P, Jakob RP (2010) Avoiding intraoperative complications in open-wedge high tibial valgus osteotomy: technical advancement. Knee Surg Sports Traumatol Arthrosc 18(2):200–203CrossRef

31.

Slocum DB, Larson RL, James SL, Grenier R (1974) High tibial osteotomy. Clin Orthop Relat Res 104:239–243CrossRef

32.

Song EK, Seon JK, Park SJ, Jeong MS (2010) The complications of high tibial osteotomy: closing-versus opening-wedge methods. J Bone Joint Surg Br 92(9):1245–1252CrossRef

33.

Lee OS, Lee YS (2018) Diagnostic value of computed tomography and risk factors for lateral hinge fracture in the open wedge high tibial osteotomy. Arthroscopy 34(4):1032–1043CrossRef

Title: Opposite hinge fractures in high tibial osteotomy: a displacement subtype is more critical than a fracture type
Authors: Anton Dorofeev
Alfred Tylla
Martin Benco
Wolf Drescher
Richard Stangl
Publication date: 01-02-2020
Publisher: Springer Paris
Keyword: Pseudarthrosis
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 2/2020
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-019-02549-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Opposite hinge fractures in high tibial osteotomy: a displacement subtype is more critical than a fracture type

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2020

Surgical technique in tension band wiring method for selected comminuted olecranon fractures

Complications and results of the arthrodesis after total ankle arthroplasty failure: a retrospective monocentric study of 12 cases

Avascular necrosis of the femoral head after single steroid intra-articular injection

Is the administration of vancomycin to operative field effective? Studying from operative wound drainage tube culture

Impact of smoking on outcomes following knee and shoulder arthroscopy

Percutaneous cannulated screw fixation in the treatment for diabetic ankle fractures