Study on lateral hinge fracture during open wedge high tibial osteotomy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Kuankuan ,  WU Min

Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233000, P.R.China;

Corresponding author：

WU Min, Email: wumin200207@163.com

Keywords：

Open wedge high tibial osteotomy; lateral hinge fracture; complication

DOI：

10.7507/1002-1892.201807049

Video：

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Objective To summarize the related research results of open wedge high tibial osteotomy (OWHTO) complicated with lateral hinge fracture. Methods To review the relevant literature of OWHTO at home and abroad in recent years and summarize and analyse the clinical experience. Results The lateral hinge rupture may occur during the OWHTO, which may lead to the loss of correction angle after operation, delayed healing or non-union of osteotomy and so on. The lateral hinge plays an important role in the stability of the osteotomy. During the operation, the " safe zone” internal osteotomy can be used to protect the bone. Once the lateral hinge breaks, the TomoFix plate can be used to obtain the sufficient stability. For patients with lateral hinge rupture, functional exercise and full weight loading time should be guided by hinge breakage classification. Conclusion The intact lateral hinge is beneficial to the healing and rehabilitation of OWHTO. The lateral hinge should be paid enough attention by clinicians.

Citation： ZHANG Kuankuan, WU Min. Study on lateral hinge fracture during open wedge high tibial osteotomy. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(1): 110-114. doi: 10.7507/1002-1892.201807049 Copy

1.	Jackson JP. Osteotomy for osteoarthritis of the knee. J Bone Joint Surg (Br), 1958, 40(4): 826.
2.	Brouwer RW, Bierma-Zeinstra SM, van Raaij TM, et al. Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A one-year randomised, controlled study. J Bone Joint Surg (Br), 2006, 88(11): 1454-1459.
3.	Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2003, 11(3): 132-138.
4.	Hankemeier S, Mommsen P, Krettek C, et al. Accuracy of high tibial osteotomy: comparison between open- and closed-wedge technique. Knee Surg Sports Traumatol Arthrosc, 2010, 18(10): 1328-1333.
5.	Staubli AE, De Simoni C, Babst R, et al. TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia-early results in 92 cases. Injury, 2003, 34(Suppl 2): B55-62.
6.	Takeuchi R, Ishikawa H, Kumagai K, et al. Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy, 2012, 28(1): 85-94.
7.	Han SB, Lee DH, Shetty GM, et al. A " safe zone” in medial open-wedge high tibia osteotomy to prevent lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc, 2013, 21(1): 90-95.
8.	van Raaij TM, Brouwer RW, de Vlieger R, et al. Opposite cortical fracture in high tibial osteotomy: lateral closing compared to the medial opening-wedge technique. Acta Orthop, 2008, 79(4): 508-514.
9.	Nelissen EM, van Langelaan EJ, Nelissen RG. Stability of medial opening wedge high tibial osteotomy: a failure analysis. Int Orthop, 2010, 34(2): 217-223.
10.	Niemeyer P, Koestler W, Kaehny C, et al. Two-year results of open-wedge high tibial osteotomy with fixation by medial plate fixator for medial compartment arthritis with varus malalignment of the knee. Arthroscopy, 2008, 24(7): 796-804.
11.	Laprade RF, Spiridonov SI, Nystrom LM, et al. Prospective outcomes of young and middle-aged adults with medial compartment osteoarthritis treated with a proximal tibial opening wedge osteotomy. Arthroscopy, 2012, 28(3): 354-364.
12.	Lee Y, Sung WJ, Seok OW, et al. Lateral tibial bone mineral density around the level of the proximal tibiofibular joint. Knee Surg Sports Traumatol Arthrosc, 2014, 22(7): 1678-1683.
13.	Nakamura R, Komatsu N, Murao T, et al. The validity of the classification for lateral hinge fractures in open wedge high tibial osteotomy. J Bone Joint Surg (Br), 2015, 97-B(9): 1226-1231.
14.	Miller BS, Dorsey WO, Bryant CR, et al. The effect of lateral cortex disruption and repair on the stability of the medial opening wedge high tibial osteotomy. Am Sports Med, 2005, 33(10): 1552-1557.
15.	Miller BS, Downie B, McDonough EB, et al. Complications after medial opening wedge high tibial osteotomy. Arthroscopy, 2009, 25(6): 639-646.
16.	Schröter S, Gonser CE, Konstantinidis L, et al. High complication rate after biplanar open wedge high tibial osteotomy stabilized with a new spacer plate (Position HTO plate) without bone substitute. Arthroscopy, 2011, 27(5): 644-652.
17.	Meidinger G, Imhoff AB, Paul J, et al. May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union Knee Surg Sports Traumatol Arthrosc, 2011, 19(3): 333-339.
18.	Spahn G. Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg, 2004, 124(10): 649-653.
19.	Jung WH, Chun CW, Lee JH, et al. Comparative study of medial opening-wedge high tibial osteotomy using 2 different implants. Arthroscopy, 2013, 29(6): 1063-1071.
20.	El-Assal MA, Khalifa YE, Abdel-Hamid MM, et al. Opening-wedge high tibial osteotomy without bone graft. Knee Surg Sports Traumatol Arthrosc, 2010, 18(7): 961-966.
21.	Jacobi M, Wahl P, Jakob PR. Avoiding intraoperative complications in open-wedge high tibial valgus osteotomy: technical advancement. Knee Surg Sports Traumatol Arthrosc, 2010, 18(2): 200-203.
22.	Steffen S, Thomas F, Matthias KM, et al. Smoking and unstable hinge fractures cause delayed gap filling irrespective of early weight bearing after open wedge osteotomy. Arthroscopy, 2015, 31(2): 254-265.
23.	Brandt KD, Dieppe P, Radin EL. Etiopathogenesis of osteoarthritis. Rheum Dis Clin North Am, 2008, 34(3): 531-559.
24.	Jo HS, Park JS, Byun JH, et al. The effects of different hinge positions on posterior tibial slope in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2018, 26(6): 1851-1858.
25.	Lee SC, Kim SJ, Jung KA, et al. An early sign of intraarticular fracture of the lateral tibial plateau during opening wedge high tibial osteotomy. Knee, 2013, 20(1): 66-68.
26.	魏伟, 沈计荣. 双平面胫骨高位截骨术治疗膝关节内侧间室骨关节炎. 中国修复重建外科杂志, 2018, 32(11): 1406-1410.
27.	王晗煦, 罗从风, 占宇. 内侧张开胫骨高位截骨治疗膝关节内侧间室骨关节炎中期随访研究. 国际骨科学杂志, 2017, 38(5): 327-331.
28.	Noyes FR, Mayfield W, Barber-Westin SD, et al. Opening wedge high tibial osteotomy: An operative technique and rehabilitation program to decrease complications and promote early union and function. Am J Sports Med, 2006, 34(8): 1262-1273.
29.	Kessler OC, Jacob HA, Romero J. Avoidance of medial cortical fracture in high tibial osteotomy: improved technique. Clin Orthop Relat Res, 2002, 395: 180-185.
30.	Diffo KA, Maas S, Hoffmann A, et al. Mechanical strength assessment of a drilled hole in the contralateral cortex at the end of the open wedge for high tibial osteotomy. Journal of Experimental Orthopaedics, 2017, 4(1): 23.
31.	Agneskircher J, Freiling D, Hurschler C, et al. Primary stability of four different implants for opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2006, 14(3): 291-300.
32.	Stoffel K, Stachowiak G, Kuster M, et al. Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biochem, 2004, 19(9): 944-950.
33.	Buckwalter JA, Martin JA. Osteoarthritis. Adv Drug Deliv Rev, 2006, 58(2): 150-167.
34.	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, 2017, 25(3): 832-837.
35.	Seki K, Sakka A, Tokushige A, et al. Treatment for Staphylococcus aureus infection following open wedge high tibial osteotomy using antibiotic-impregnated calcium phosphate cement. Knee Surg Sports Traumatol Arthrosc, 2014, 22(11): 2614-2617.
36.	Takeuchi R, Ishikawa H, Aratake M, et al. Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy, 2009, 25(1): 46-53.
37.	Egger EL, Gottsauner-Wolf F, Palmer J, et al. Effects of axial dynamization on bone healing. Trauma, 1993, 34(2): 185-192.
38.	Brinkman JM, Luites JW, Wymenga AB, et al. Early full weight bearing is safe in open-wedge high tibial osteotomy: RSA analysis of postoperative stability compared to delayed weight bearing. Acta Orthop, 2010, 81(2): 193-198.
39.	Takeuchi R, Aratake M, Bito H, et al. Simultaneous bilateral opening-wedge high tibial osteotomy with early full weight-bearing exercise. Knee Surg Sports Traumatol Arthrosc, 2008, 16(11): 1030-1037.

1. Jackson JP. Osteotomy for osteoarthritis of the knee. J Bone Joint Surg (Br), 1958, 40(4): 826.
2. Brouwer RW, Bierma-Zeinstra SM, van Raaij TM, et al. Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A one-year randomised, controlled study. J Bone Joint Surg (Br), 2006, 88(11): 1454-1459.
3. Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2003, 11(3): 132-138.
4. Hankemeier S, Mommsen P, Krettek C, et al. Accuracy of high tibial osteotomy: comparison between open- and closed-wedge technique. Knee Surg Sports Traumatol Arthrosc, 2010, 18(10): 1328-1333.
5. Staubli AE, De Simoni C, Babst R, et al. TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia-early results in 92 cases. Injury, 2003, 34(Suppl 2): B55-62.
6. Takeuchi R, Ishikawa H, Kumagai K, et al. Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy, 2012, 28(1): 85-94.
7. Han SB, Lee DH, Shetty GM, et al. A " safe zone” in medial open-wedge high tibia osteotomy to prevent lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc, 2013, 21(1): 90-95.
8. van Raaij TM, Brouwer RW, de Vlieger R, et al. Opposite cortical fracture in high tibial osteotomy: lateral closing compared to the medial opening-wedge technique. Acta Orthop, 2008, 79(4): 508-514.
9. Nelissen EM, van Langelaan EJ, Nelissen RG. Stability of medial opening wedge high tibial osteotomy: a failure analysis. Int Orthop, 2010, 34(2): 217-223.
10. Niemeyer P, Koestler W, Kaehny C, et al. Two-year results of open-wedge high tibial osteotomy with fixation by medial plate fixator for medial compartment arthritis with varus malalignment of the knee. Arthroscopy, 2008, 24(7): 796-804.
11. Laprade RF, Spiridonov SI, Nystrom LM, et al. Prospective outcomes of young and middle-aged adults with medial compartment osteoarthritis treated with a proximal tibial opening wedge osteotomy. Arthroscopy, 2012, 28(3): 354-364.
12. Lee Y, Sung WJ, Seok OW, et al. Lateral tibial bone mineral density around the level of the proximal tibiofibular joint. Knee Surg Sports Traumatol Arthrosc, 2014, 22(7): 1678-1683.
13. Nakamura R, Komatsu N, Murao T, et al. The validity of the classification for lateral hinge fractures in open wedge high tibial osteotomy. J Bone Joint Surg (Br), 2015, 97-B(9): 1226-1231.
14. Miller BS, Dorsey WO, Bryant CR, et al. The effect of lateral cortex disruption and repair on the stability of the medial opening wedge high tibial osteotomy. Am Sports Med, 2005, 33(10): 1552-1557.
15. Miller BS, Downie B, McDonough EB, et al. Complications after medial opening wedge high tibial osteotomy. Arthroscopy, 2009, 25(6): 639-646.
16. Schröter S, Gonser CE, Konstantinidis L, et al. High complication rate after biplanar open wedge high tibial osteotomy stabilized with a new spacer plate (Position HTO plate) without bone substitute. Arthroscopy, 2011, 27(5): 644-652.
17. Meidinger G, Imhoff AB, Paul J, et al. May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union Knee Surg Sports Traumatol Arthrosc, 2011, 19(3): 333-339.
18. Spahn G. Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg, 2004, 124(10): 649-653.
19. Jung WH, Chun CW, Lee JH, et al. Comparative study of medial opening-wedge high tibial osteotomy using 2 different implants. Arthroscopy, 2013, 29(6): 1063-1071.
20. El-Assal MA, Khalifa YE, Abdel-Hamid MM, et al. Opening-wedge high tibial osteotomy without bone graft. Knee Surg Sports Traumatol Arthrosc, 2010, 18(7): 961-966.
21. Jacobi M, Wahl P, Jakob PR. Avoiding intraoperative complications in open-wedge high tibial valgus osteotomy: technical advancement. Knee Surg Sports Traumatol Arthrosc, 2010, 18(2): 200-203.
22. Steffen S, Thomas F, Matthias KM, et al. Smoking and unstable hinge fractures cause delayed gap filling irrespective of early weight bearing after open wedge osteotomy. Arthroscopy, 2015, 31(2): 254-265.
23. Brandt KD, Dieppe P, Radin EL. Etiopathogenesis of osteoarthritis. Rheum Dis Clin North Am, 2008, 34(3): 531-559.
24. Jo HS, Park JS, Byun JH, et al. The effects of different hinge positions on posterior tibial slope in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2018, 26(6): 1851-1858.
25. Lee SC, Kim SJ, Jung KA, et al. An early sign of intraarticular fracture of the lateral tibial plateau during opening wedge high tibial osteotomy. Knee, 2013, 20(1): 66-68.
26. 魏伟, 沈计荣. 双平面胫骨高位截骨术治疗膝关节内侧间室骨关节炎. 中国修复重建外科杂志, 2018, 32(11): 1406-1410.
27. 王晗煦, 罗从风, 占宇. 内侧张开胫骨高位截骨治疗膝关节内侧间室骨关节炎中期随访研究. 国际骨科学杂志, 2017, 38(5): 327-331.
28. Noyes FR, Mayfield W, Barber-Westin SD, et al. Opening wedge high tibial osteotomy: An operative technique and rehabilitation program to decrease complications and promote early union and function. Am J Sports Med, 2006, 34(8): 1262-1273.
29. Kessler OC, Jacob HA, Romero J. Avoidance of medial cortical fracture in high tibial osteotomy: improved technique. Clin Orthop Relat Res, 2002, 395: 180-185.
30. Diffo KA, Maas S, Hoffmann A, et al. Mechanical strength assessment of a drilled hole in the contralateral cortex at the end of the open wedge for high tibial osteotomy. Journal of Experimental Orthopaedics, 2017, 4(1): 23.
31. Agneskircher J, Freiling D, Hurschler C, et al. Primary stability of four different implants for opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2006, 14(3): 291-300.
32. Stoffel K, Stachowiak G, Kuster M, et al. Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biochem, 2004, 19(9): 944-950.
33. Buckwalter JA, Martin JA. Osteoarthritis. Adv Drug Deliv Rev, 2006, 58(2): 150-167.
34. 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, 2017, 25(3): 832-837.
35. Seki K, Sakka A, Tokushige A, et al. Treatment for Staphylococcus aureus infection following open wedge high tibial osteotomy using antibiotic-impregnated calcium phosphate cement. Knee Surg Sports Traumatol Arthrosc, 2014, 22(11): 2614-2617.
36. Takeuchi R, Ishikawa H, Aratake M, et al. Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy, 2009, 25(1): 46-53.
37. Egger EL, Gottsauner-Wolf F, Palmer J, et al. Effects of axial dynamization on bone healing. Trauma, 1993, 34(2): 185-192.
38. Brinkman JM, Luites JW, Wymenga AB, et al. Early full weight bearing is safe in open-wedge high tibial osteotomy: RSA analysis of postoperative stability compared to delayed weight bearing. Acta Orthop, 2010, 81(2): 193-198.
39. Takeuchi R, Aratake M, Bito H, et al. Simultaneous bilateral opening-wedge high tibial osteotomy with early full weight-bearing exercise. Knee Surg Sports Traumatol Arthrosc, 2008, 16(11): 1030-1037.

Chinese Journal of Reparative and Reconstructive Surgery

Study on lateral hinge fracture during open wedge high tibial osteotomy

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