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Posterior cortical breakage leads to posterior tibial slope change in lateral hinge fracture following opening wedge high tibial osteotomy

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study was designed to analyze the relationship between changes in posterior tibial slope and the absence or presence of lateral hinge fracture, diagnosed in the sagittal and axial planes, as well as the coronal plane, by computed tomography (CT) following opening wedge high tibial osteotomy (HTO).

Methods

This study involved 55 patients (55 knees) undergoing opening wedge HTO for primary medial osteoarthritis. Lateral hinge fractures were evaluated on CT scans according to the Takeuchi classification and were also classified as subtypes A, B, and C, depending on anterior, posterior, and both anterior and posterior cortical disruptions, respectively, as determined by the sagittal and axial planes of CT scans which corresponded to the fracture line visible on coronal CT scans.

Results

Of the 55 knees, 23 were found on postoperative CT scans to have lateral hinge fractures. All 23 were classified as Type I, with 11, 12, and 0 being subtypes A, B, and C, respectively. Mean change in posterior tibial slope from 3 weeks postoperatively to last follow up in subtype B was significantly greater than in subtype A (2.5° vs 0.2°, P = 0.008) and in knees without hinge fracture (2.5° vs 0.1°, P = 0.002).

Conclusion

Type I lateral hinge fractures encroached either the anterior or posterior cortex of the proximal tibia, but not both. In addition, posterior tibial slope increased over time following surgery in knees with Type I lateral hinge fracture and posterior cortex breakage, suggesting that caution should be exercised when deciding the starting time for weight bearing in such patients.

Level of evidence

Case series, Level IV.

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Author notes

  1. Sung-Sahn Lee and Kyung-Wook Nha contributed equally to the work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 06351, South Korea

    Sung-Sahn Lee & Dae-Hee Lee

  2. Department of Orthopaedic Surgery, Ilsanpaik Hospital, Inje University College of Medicine, Goyangsi, Gyeonggido, South Korea

    Kyung-Wook Nha

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  1. Sung-Sahn Lee
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  2. Kyung-Wook Nha
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  3. Dae-Hee Lee
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Correspondence to Dae-Hee Lee.

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This article does not contain any studies with human participants performed by any of the authors.

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Lee, SS., Nha, KW. & Lee, DH. Posterior cortical breakage leads to posterior tibial slope change in lateral hinge fracture following opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 27, 698–706 (2019). https://doi.org/10.1007/s00167-018-4977-4

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  • DOI: https://doi.org/10.1007/s00167-018-4977-4

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