Editorial Commentary: Biomechanical Studies Show Lateral Hinge Screws May Increase Load to Failure After Medial Opening Wedge High Tibial Osteotomy.

Lateral hinge fracture (LHF) is a common complication following medial opening wedge high tibial osteotomy occurring in up to 32%-50% of cases. This can lead to delayed union, nonunion, and loss of correction. Larger medial opening gap width is the most consistently identified risk factor, though lateral hinge width, osteotomy level, and uniplanar versus biplanar technique have also been implicated. To mitigate the risk of postoperative LHF, lateral hinge screws, inserted after osteotomy fixation, improve the ultimate strength of the osteotomy construct, demonstrating a 30% increase in resistance to varus loading and increased load to failure 2-3x in response to compressive stress. Despite these biomechanical findings, clinical translation remains a critical next step.