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Open-wedge high tibial osteotomy: incidence of lateral cortex fractures and influence of fixation device on osteotomy healing

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

Abstract

Purpose

Open-wedge high tibial osteotomy (HTO) is an established treatment for young and middle-aged patients with medial compartment knee osteoarthritis and varus malalignment. Although not intended, a lateral cortex fracture might occur during this procedure. Different fixation devices are available to repair such fractures. This study was performed to evaluate osteotomy healing after fixation with two different locking plates.

Methods

Sixty-nine medial open-wedge HTO without bone grafting were followed until osteotomy healing.

Results

In patients with an intact lateral hinge, no problems were noted with either locking plate. A fracture of the lateral cortex occurred in 21 patients (30.4 %). In ten patients, the fracture was not recognized during surgery but was visible on the radiographs at the 6-week follow-up. Lateral cortex fracture resulted in non-union with the need for surgical treatment in three out of eight (37.5 %) patients using the newly introduced locking plate (Position HTO Maxi Plate), while this did not occur with a well-established locking plate (TomoFix) (0 out of 13, p = 0.023).

Conclusion

With regard to other adverse events, no differences between both implants were observed. In cases of lateral cortex fracture, fixation with a smaller locking plate resulted in a relevant number of non-unions. Therefore, it is recommended that bone grafting, another fixation system, or an additional lateral fixation should be used in cases with lateral cortex fracture.

Level of evidence

III.

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, University Hospital Carl Gustav Carus, Medical Faculty of the Technical University of Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    Julian Dexel, Hagen Fritzsche, Franziska Beyer & Jörg Lützner

  2. Department of Bioengineering, Clemson University, Clemson, SC, USA

    Melinda K. Harman

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  1. Julian Dexel
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  2. Hagen Fritzsche
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  3. Franziska Beyer
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  5. Jörg Lützner
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Correspondence to Julian Dexel.

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Conflict of interest

There has been no funding for this study. The authors’ institution has received research grants for different studies from Aesculap, Mathys, Smith and Nephew and Zimmer. One author (JL) has received payments for presentations from Aesculap and Mathys.

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Dexel, J., Fritzsche, H., Beyer, F. et al. Open-wedge high tibial osteotomy: incidence of lateral cortex fractures and influence of fixation device on osteotomy healing. Knee Surg Sports Traumatol Arthrosc 25, 832–837 (2017). https://doi.org/10.1007/s00167-015-3730-5

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  • DOI: https://doi.org/10.1007/s00167-015-3730-5

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