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Larger lateral hinges increase the probability of Takeuchi type II and III fractures in high tibial osteotomy

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Lateral hinge fractures are the main complications in the high tibial osteotomy to treat varus deformities. The aim of present study is to answer the question whether the lateral hinge length (H) has an effect on the type of fracture and required force during the opening in high tibia osteotomy. It was hypothesized in this comparative research that extending the hinge length increased opening force and probability of a type II and type III fractures.

Methods

A monoplanar medial open wedge osteotomy with different intact hinge lengths varying from 9 to 32 mm was performed in 20 ostrich bones. A biomechanical experiment using unidirectional tensile testing apparatus was performed to open the wedge, and the required force was increased until a 10 mm opening was reached; then, the presence of fracture in the lateral cortex and its direction were evaluated. Lateral hinge fracture type based on direction was classified as suggested by Takeuchi et al.

Results

Fracture that grows along the osteotomy line (type I) was observed in 4 samples with the mean hinge length (H) of 11 ± 1.54 mm. For seven bones with Takeuchi fracture type II, with downward crack propagation, the mean H was 16 ± 3.36 mm. For the mean H of 25 ± 6.53 mm, the crack propagated upward to the cutting path, displaying a Takeuchi type III fracture in seven samples. The statistical analysis showed that the fracture type significantly depends on the hinge length (P value < 0.05). Also, the mean opening force significantly increased with hinge lengthening (P value < 0.05). The peak forces at crack initiation were 41.8 ± 21.9, 115.2 ± 41.5, and 167 ± 135.3 N, respectively, for the fracture types I, II, and III samples.

Conclusion

The lateral cortical hinge length was significantly associated with hinge fracture type. The experimental tests indicated that the hinge lengthening increases the risk of type II and III fractures, as classified by Takeuchi.

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Acknowledgements

The authors acknowledge Tajhiz Sina for providing an orthopedic oscillating saw device to perform the cut.

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Authors and Affiliations

  1. Biomechanical Engineering Group, Department of Biomedical Engineering, Amirkabir University of Technology, Hafez Avenue, Tehran, 15875, Iran

    Zahra Saghaei, Saeed Salehipour & Ata Hashemi

Authors
  1. Zahra Saghaei
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  2. Saeed Salehipour
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  3. Ata Hashemi
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Correspondence to Ata Hashemi.

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The authors whose names are listed immediately below certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

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The bones were acquired from a local meat wholesaler and since no animal participant was involved in this study, no approval was required.

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Saghaei, Z., Salehipour, S. & Hashemi, A. Larger lateral hinges increase the probability of Takeuchi type II and III fractures in high tibial osteotomy. Eur J Orthop Surg Traumatol (2024). https://doi.org/10.1007/s00590-024-03935-5

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