The Type of Lateral Hinge Fracture in Medial Open-Wedge High Tibial Osteotomy Determines Its Stability: A Biomechanical Study.

Christian Peez,Alexander Milstrey,Ivan Zderic,Adrian Deichsel,R Geoff Richards,Boyko Gueorguiev,Christoph Kittl,Michael J Raschke,Elmar Herbst
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Abstract

BACKGROUND Lateral hinge fractures (LHFs) are considered risk factors for delayed union or nonunion after medial open-wedge high tibial osteotomies (MOWHTOs). However, there is limited evidence on the extent to which the morphology of the hinge fracture influences the stability of a MOWHTO. PURPOSE/HYPOTHESIS The purpose of this study was to validate the Takeuchi classification under axial and torsional loading to identify the LHF types requiring surgical treatment. It was hypothesized that (1) LHFs would reduce construct stiffness and increase interfragmentary instability across the osteotomy gap, and (2) shear displacement associated with impaired bone healing of >2 mm would be observed in Takeuchi type 2 and 3 fractures. STUDY DESIGN Descriptive laboratory study. METHODS A total of 24 fresh-frozen human cadaveric proximal tibiae underwent MOWHTO fixed with a locking compression plate. The specimens were assigned to 3 different groups so that the mean bone mineral density values were similar between the groups. Each group simulated a different type of LHF according to the Takeuchi classification: (1) type 1 fracture, extension along the osteotomy plane; (2) type 2 fracture, extension distal to the proximal tibiofibular joint; and (3) type 3 fracture, proximal extension into the lateral tibial plateau. Each specimen was subjected to 10 quasi-static cycles of axial compression up to 720 N, followed by internal and external torsional loading up to 10 N·m, while the interfragmentary movements were captured with a motion tracking system. RESULTS Compared with a MOWHTO with a preserved lateral hinge, Takeuchi type 2 and 3 fractures significantly increased shear displacement and hinge rotation by 2.2 mm and 2.3°, respectively, resulting in at least 80% reduction in torsional stiffness (P < .001). In contrast, Takeuchi type 1 fractures did not significantly alter the torsional stability of a MOWHTO. Takeuchi type 2 and 3 fractures significantly increased axial displacement at the hinge site by 0.2 mm (P < .01) compared with an intact hinge MOWHTO, while axial displacement of the medial osteotomy gap remained unchanged. All Takeuchi types significantly reduced axial construct stiffness by at least 28% (P < .01). CONCLUSION From a biomechanical perspective, Takeuchi type 1 LHFs did not affect the torsional stability of MOWHTO, whereas Takeuchi type 2 and 3 fractures resulted in significantly reduced torsional stiffness, increased shear displacement, and hinge rotation across the osteotomy gap. All Takeuchi fracture types resulted in reduced axial construct stiffness, while axial displacement was not significantly affected by the type of hinge fracture. CLINICAL RELEVANCE The observed shear displacement of >2 mm for Takeuchi type 2 and 3 fractures may be indicative of impaired bone healing and may therefore qualify these fractures for hinge fixation to potentially reduce the risk of delayed union and nonunion.
胫骨内侧开楔高位截骨术中外侧铰链骨折类型决定其稳定性:一项生物力学研究。
背景:外侧铰链骨折(LHFs)被认为是内侧开楔高位胫骨截骨术(MOWHTOs)后延迟愈合或不愈合的危险因素。然而,关于铰链断裂形态对MOWHTO稳定性的影响程度的证据有限。目的/假设本研究的目的是验证Takeuchi在轴向和扭转载荷下的分类,以确定需要手术治疗的LHF类型。假设:(1)LHFs会降低结构刚度并增加截骨间隙的碎片间不稳定性;(2)在Takeuchi 2型和3型骨折中会观察到与bbbb2 mm骨愈合受损相关的剪切位移。研究设计描述性实验室研究。方法对24例新鲜冷冻人尸体胫骨近端用锁定加压钢板进行MOWHTO固定。将标本分为3个不同的组,使各组间的平均骨密度值相近。根据Takeuchi分类,每组模拟不同类型的LHF:(1) 1型骨折,沿截骨平面延伸;(2) 2型骨折,远端延伸至近端胫腓关节;(3) 3型骨折,近端延伸至胫骨外侧平台。每个试样经受了10次轴向压缩(720 N)的准静态循环,然后是10 N·m的内外扭转加载,同时运动跟踪系统捕获了碎片间的运动。结果与保留外侧铰链的MOWHTO相比,Takeuchi 2型和3型骨折的剪切位移和铰链旋转分别显著增加2.2 mm和2.3°,扭转刚度降低至少80% (P < 0.001)。相反,Takeuchi 1型骨折没有显著改变MOWHTO的扭转稳定性。与完整的铰链MOWHTO相比,Takeuchi 2型和3型骨折在铰链部位的轴向位移显著增加0.2 mm (P < 0.01),而内侧截骨间隙的轴向位移保持不变。所有Takeuchi类型均可显著降低轴向结构刚度至少28% (P < 0.01)。结论从生物力学角度来看,Takeuchi 1型LHFs不影响MOWHTO的扭转稳定性,而Takeuchi 2型和3型骨折导致扭转刚度显著降低,剪切位移增加,铰链旋转穿过截骨间隙。所有Takeuchi骨折类型都导致轴向构造刚度降低,而轴向位移受铰链骨折类型的影响不显著。临床意义:Takeuchi 2型和3型骨折观察到的bbb2.0 mm的剪切移位可能表明骨愈合受损,因此可能有资格对这些骨折进行铰链固定,以潜在地降低延迟愈合和不愈合的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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