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Distalization of hinge site with use of hinge wire reduces hinge fracture rates in closing wedge distal femoral osteotomy

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

Abstract

Purpose

Closing wedge distal femoral osteotomies (CWDFO) are attractive treatment options for unicompartmental knee osteoarthritis with coronal plane deformity. However, it has been traditionally associated with high rates of hinge fracture that can adversely impact recovery and patient outcomes. Appropriate siting of hinge point can be an effective method of reducing the incidence of hinge fractures. This study aims to illustrate a case series of CWDFO with low rates of hinge fracture utilising our preferred hinge point site.

Methods

A retrospective study of a cohort of 39 CWDFO was performed between May 2019 and May 2022. Both medial and lateral CWDFO were included. The hinge point in all cases was placed at the level of the inferior margin of the metaphyseal flare, and inferior to the gastrocnemius origin, with a hinge thickness of 10 mm. Post-operative radiographs were obtained at 2, 4 and 8 weeks after surgery to assess for hinge fracture and union.

Results

Thirty-nine cases of CWDFO were performed, consisting of eighteen cases of valgus malalignment that underwent medial CWDFO and twenty-one cases of varus malalignment that underwent lateral CWDFO. At surgery, the mean age was 47.6 (± 13.9) years and mean BMI was 29.4 (± 4.9). There were 23 men and 16 women. Three cases of hinge fractures occurred intraoperatively, translating into a hinge fracture rate of 7.69%. However, union was achieved in all three cases and all patients in this case series were able to progress to weight bear as tolerated at 2 months post-osteotomy.

Conclusion

Distal placement of the hinge at the level of the inferior metaphyseal flare margin with the use of a hinge wire can greatly reduce the rates of hinge fracture in CWDFO.

Level of evidence

Level III.

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Funding

No funding was received in relation to the conduct of this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore

    Shao Jin Teo, Don Thong Siang Koh, Jun Wei Soong, William Yeo & Kong Hwee Lee

  2. Department of Trauma and Orthopaedics, Basingstoke &, North Hampshire Hospital, Basingstoke, UK

    Adrian Wilson

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  1. Shao Jin Teo
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  2. Don Thong Siang Koh
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  3. Jun Wei Soong
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  4. William Yeo
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  5. Adrian Wilson
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Contributions

KHL and AW conceived of the study and the clinical relevance of the result. SJT, DTSK and SJW participated in the collection, sorting and analysis of the data, as well as the subsequent drafting of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Shao Jin Teo.

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Conflict of interest

Adrian Wilson receives royalties from Arthrex and Newclip.

Ethical approval

Approval was received from the Institutional Review Board prior to the conduct of this study.

Informed consent

Data utilised in the conduct of this study were fully anonymized with all patient identifiers removed by an institution appointed independent third party. As such, a waiver for informed consent was sought and granted by the Institutional Review Board.

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Teo, S.J., Koh, D.T.S., Soong, J.W. et al. Distalization of hinge site with use of hinge wire reduces hinge fracture rates in closing wedge distal femoral osteotomy. Knee Surg Sports Traumatol Arthrosc 31, 3141–3150 (2023). https://doi.org/10.1007/s00167-022-07286-8

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  • DOI: https://doi.org/10.1007/s00167-022-07286-8

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