The prevention of a lateral hinge fracture as a complication of a medial opening wedge high tibial osteotomy A CASE CONTROL STUDY

被引:67
|
作者
Ogawa, H. [1 ,2 ]
Matsumoto, K. [1 ]
Akiyama, H. [1 ]
机构
[1] Gifu Univ, Dept Orthopaed Surg, Grad Sch Med, Yanagido 1-1, Gifu 5011194, Japan
[2] Gifu Univ, Dept Adv Joint Reconstruct Surg, Yanagido 1-1, Gifu 5011194, Japan
来源
BONE & JOINT JOURNAL | 2017年 / 99B卷 / 07期
关键词
OSTEOARTHRITIS; KNEE; CLASSIFICATION; FIXATION; DEVICE;
D O I
10.1302/0301-620X.99B7.BJJ-2016-0927.R1
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Aims We aimed to investigate factors related to the technique of medial opening wedge high tibial osteotomy which might predispose to the development of a lateral hinge fracture. Patients and Methods A total of 71 patients with 82 osteotomies were included in the study. Their mean age was 62.9 years (37 to 80). The classification of the type of osteotomy was based on whether it extended beyond the fibular head. The level of the osteotomy was classified according to the height of its endpoint. Results At a mean follow-up of 20 months (6 to 52), a total of 15 lateral hinge fractures (18.3%) were identified. A sufficient osteotomy, in which both anterior and posterior tibial cortices were involved with extension into the lateral aspect of the plateau in relation to an anteroposterior line tangential to the medial edge of the fibular head in the CT axial plane, was seen in 48 knees (71.6%) in those without a lateral hinge fracture and in seven (46.7%) in those with a lateral hinge fracture. An osteotomy which ended above the level of the fibular head was seen in nine (13.4%) of the knees without a lateral hinge fracture and seven (46.7%) of the those with a lateral hinge fracture. There was a significant relationship between the absence of a lateral hinge fracture and both a sufficient osteotomy and one whose endpoint was at the level of the fibular head (p = 0.0451 and p = 0.0214, respectively). Conclusion A sufficient osteotomy involving both the anterior and posterior cortices, whose endpoint is at the level of the fibular head, should be performed when undertaking a medial opening wedge high tibial osteotomy if a lateral hinge fracture is to be avoided as a complication.
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收藏
页码:887 / 893
页数:7
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