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Ferner F, Hammersdorfer N, Hembus J, Saß JO, Bader R, Klinder A, Hiepe L, Holl N, Lutter C. Hinge screw or no hinge stabilization provides decreased stability compared to hinge plate in a biomechanical evaluation of distal femoral derotational osteotomies. Knee Surg Sports Traumatol Arthrosc 2024; 32:2120-2128. [PMID: 38741377 DOI: 10.1002/ksa.12251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Derotational distal femoral osteotomy (DFO) is the causal treatment for patients with femoral torsional deformity. The fixation is achieved by a unilateral angle-stable plate. Delayed- or non-unions are one of the main risks of the procedure. An additional contralateral fixation may benefit the outcome. Therefore, we hypothesize that primary stability in DFO can be improved by an additional fixation with a hinge screw or an internal plate. METHODS Derotational DFO was performed in 15 knees and fixed either with an angle-stable plate only (group 'None'), with an additional lateral screw (group 'Screw') or with an additional lateral plate (group 'Plate'). Biomechanical evaluation was carried out under axial loading of 150 N (partial weight bearing) and 800 N (full weight bearing), followed by internal and external rotation. After linear axial loading in step 1, a cyclic torsional load of 5 Nm was applied under constant axial load in step 2. In step 3, the specimens were unloaded. Micromovements between the distal and proximal parts of the osteotomy were recorded at each step for all specimens. RESULTS In step 1, the extent of micromovements was highest in group 'None' and lowest in group 'Plate' without being significantly different. In step 2, group 'Plate' showed significantly higher stability, reflected by less rotation and lower micromovements. Increasing the axial load from 150 to 800 N at step 2 resulted in increased stability in all groups but only reached significance in group 'None'. CONCLUSION An additional contralateral plate significantly increased stability in derotational DFO compared to the unilateral angle-stable plate only. Contrary, a contralateral hinge screw did not provide improved stability. STUDY DESIGN Experimental study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Felix Ferner
- Department of Orthopaedic Surgery, Hospital Lichtenfels, Lichtenfels, Germany
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
- Osteotomie Komitee, Deutsche Kniegesellschaft (German Knee Society), Schwarzenbek, Germany
| | - Nele Hammersdorfer
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Jessica Hembus
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Jan-Oliver Saß
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Annett Klinder
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Laura Hiepe
- Institute of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Norman Holl
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Christoph Lutter
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
- Osteotomie Komitee, Deutsche Kniegesellschaft (German Knee Society), Schwarzenbek, Germany
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Chen KJ, Hsiung W, Wang CY, Lee OKS, Huang KK, Huang Y, Yang JCS. Comparison of double chevron-cut and biplanar distal femoral osteotomy techniques: A biomechanical study. PLoS One 2024; 19:e0296300. [PMID: 38635518 PMCID: PMC11025861 DOI: 10.1371/journal.pone.0296300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/10/2023] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVE This study aimed to compare the stability and mechanical properties of the double chevron-cut (DCC) and biplanar (BP) distal femoral osteotomy (DFO) techniques, along with analyzing their respective contact surface areas. METHODS Biomechanical testing was performed using sawbone and 3D modeling techniques to assess axial and torsional stability, torsional stiffness, and maximum torque of both osteotomy configurations. Additionally, 3D models of the sawbone femur were created to calculate and compare the contact surface area of the DCC, BP, and conventional single-plane DFO techniques. RESULTS Axial stiffness and maximum strength did not significantly differ between the two osteotomy techniques. However, in terms of torsional properties, the DCC technique exhibited superior torsional stiffness compared to the BP group (27 ± 7.7 Nm/° vs. 4.5 ± 1.5 Nm/°, p = 0.008). Although the difference in maximum torque did not reach statistical significance (63 ± 10.6 vs. 56 ± 12.1, p = 0.87), it is noteworthy that the DCC group sawbone model exhibited fracture in the shaft region instead of at the osteotomy site. Therefore, the actual maximum torque of the DCC construct may not be accurately reflected by the numerical values obtained in this study. The contact surface area analysis revealed that the BP configuration had the largest contact surface area, 111% larger than that of the single-plane configuration. but 60% of it relied on the less reliable axial cut. Conversely, the DCC osteotomy offered a 31% larger contact surface area than the single-plane configuration, with both surfaces being weight-bearing. CONCLUSION The DCC osteotomy exhibited superior mechanical stability, showing improved rotational stiffness and maximum torque when compared to the BP osteotomy. Although the BP osteotomy resulted in a larger contact surface area than the DCC osteotomy, both were larger than the conventional single-plane configuration. In clinical practice, both the DCC and BP techniques should be evaluated based on patient-specific characteristics and surgical goals.
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Affiliation(s)
- Kuan-Jung Chen
- Department of Orthopaedics, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei Hsiung
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Orthopaedics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chien-Yuan Wang
- Department of Orthopaedics, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
- Department of Orthopaedics, College of Medicine, China Medical University, Taichung, Taiwan
| | - Oscar Kuang-Sheng Lee
- Department of Orthopaedics, College of Medicine, China Medical University, Taichung, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Translational Genomics and Regenerative Medicine, China Medical University Hospital, Taichung, Taiwan
- Stem Cell Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuo-Kuang Huang
- Department of Information Science, National Penghu University of Science and Technology, Penghu, Taiwan
| | - Ye Huang
- Department of Orthopedics, Knee Preservation Clinical and Research Center, Beijing Jishuitan Hospital, Beijing, China
| | - Jesse Chieh-Szu Yang
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
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Tanaka A, Matsushita T, Nakatsuji T, Katsui Y, Nagai K, Nishida K, Mukai T, Kuroda R. Setting hinge position distal to the proximal margin of the distal lateral femur reduces the maximum principal strains of the hinge area and risk of hinge fractures. J Exp Orthop 2024; 11:e12015. [PMID: 38590755 PMCID: PMC11000132 DOI: 10.1002/jeo2.12015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/06/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose The optimal hinge position to prevent hinge fractures in medial closing wedge distal femoral osteotomy (MCWDFO) based on the biomechanical background has not yet been well examined. This study aimed to examine the appropriate hinge position in MCWDFO using finite element (FE) analysis to prevent hinge fractures. Methods Computer-aided design (CAD) models were created using composite replicate femurs. FE models of the MCWDFO with a 5° wedge were created with three different hinge positions: (A) 5 mm proximal to the proximal margin of the lateral epicondylar region, (B) proximal margin level and (C) 5 mm distal to the proximal margin level. The maximum and minimum principal strains in the cortical bone were calculated for each model. To validate the FE analysis, biomechanical tests were performed using composite replicate femurs with the same hinge position models as those in the FE analysis. Results In the FE analysis, the maximum principal strains were in the order of Models A > B > C. The highest value of maximum principal strain was observed in the area proximal to the hinge. In the biomechanical test, hinge fractures occurred in the area proximal to the hinge in Models A and B, whereas the gap closed completely without hinge fractures in Model C. Fractures occurred in an area similar to where the highest maximal principal strain was observed in the FE analysis. Conclusion Distal to the proximal margin of the lateral epicondylar region is an appropriate hinge position in MCWDFO to prevent hinge fractures. Level of Evidence Level V.
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Affiliation(s)
- Atsuki Tanaka
- Department of Orthopaedic SurgeryKobe University Graduate School of MedicineKobeHyogoJapan
| | - Takehiko Matsushita
- Department of Orthopaedic SurgeryKobe University Graduate School of MedicineKobeHyogoJapan
| | - Tatsuya Nakatsuji
- Department of Mechanical EngineeringKobe University Graduate School of EngineeringKobeHyogoJapan
| | - Yosuke Katsui
- Department of Mechanical EngineeringKobe University Graduate School of EngineeringKobeHyogoJapan
| | - Kanto Nagai
- Department of Orthopaedic SurgeryKobe University Graduate School of MedicineKobeHyogoJapan
| | - Kyohei Nishida
- Department of Orthopaedic SurgeryKobe University Graduate School of MedicineKobeHyogoJapan
| | - Toshiji Mukai
- Department of Mechanical EngineeringKobe University Graduate School of EngineeringKobeHyogoJapan
| | - Ryosuke Kuroda
- Department of Orthopaedic SurgeryKobe University Graduate School of MedicineKobeHyogoJapan
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Oda T, Maeyama A, Ishimatsu T, Tachibana K, Yoshimitsu K, Yamamoto T. Soft Tissue Stabilization of the Hinge Position for Lateral Closing-Wedge Distal Femoral Osteotomy: An Anatomic Study. Orthop J Sports Med 2024; 12:23259671241233014. [PMID: 38510318 PMCID: PMC10952986 DOI: 10.1177/23259671241233014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 03/22/2024] Open
Abstract
Background Soft tissue plays an important role in stabilizing the hinge point for osteotomy around the knee. However, insufficient data are available on the anatomic features of the soft tissue around the hinge position for lateral closing-wedge distal femoral osteotomy (LCWDFO). Purpose To (1) anatomically analyze the soft tissue around the hinge position for LCWDFO, (2) histologically analyze the soft tissue based on the anatomic analysis results, and (3) radiologically define the appropriate hinge point to prevent unstable hinge fracture based on the results of the anatomic and histological analyses. Study Design Descriptive laboratory study. Methods In 20 cadaveric knees (age, 82.7 ± 7.8 years; range, 60-96 years), the soft tissue of the distal medial side of the femur was anatomically analyzed. The thicknesses of the periosteum and direct insertion of the adductor tendon (AT) were histologically examined and measured using an electron microscope. The thickness of the periosteum was visualized graphically, and the graph of the periosteum and radiograph of the knee were overlaid using image editing software. The appropriate hinge position was determined based on the periosteal thickness and attachment of the AT. Results The mean thickness of the periosteum of the metaphysis was 352.7 ± 58.6 µm (range, 213.6-503.4 µm). The overlaid graph and radiograph revealed that the thickness of the periosteum changed at the part corresponding to the transition between the diaphyseal and metaphyseal ends of the femur. The mean width of the AT attached to the distal medial femur from the adductor tubercle toward the distal direction was 7.9 ± 1.3 mm (range, 6.3-9.7 mm). Conclusion Results indicated that the periosteum and AT support the hinge for LCWDFO within the area surrounded by the apex of the adductor tubercle and the upper border of the posterior part of the lateral femoral condyle. Clinical Relevance When the hinge point is located within the area surrounded by the apex of the adductor tubercle and the upper border of the posterior part of the lateral femoral condyle, these soft tissues work as stabilizers, and there is no risk of cutting into the joint space.
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Affiliation(s)
- Taiga Oda
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Akira Maeyama
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Tetsuro Ishimatsu
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Katsuro Tachibana
- Department of Anatomy, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kengo Yoshimitsu
- Department of Radiology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Watrinet J, Joergens M, Blum P, Ehmann Y, Augat P, Stuby F, Schröter S, Harrer J, Fürmetz J. Tibial tuberosity-trochlear groove distance is significantly decreased by medial closing wedge distal femoral osteotomy. Knee Surg Sports Traumatol Arthrosc 2024; 32:287-294. [PMID: 38270286 DOI: 10.1002/ksa.12053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE While medial closing wedge distal femoral osteotomy (MCWDFO) has been used to address patella instability combined with valgus malalignment, its impact on patellofemoral parameters remains uncharted. Hence, this study seeks to establish a three-dimensional (3D) planning of MCWDFO and measure its effect on the tibial tubercle - trochlear groove distance (TTTG) through simulation and calculation. METHODS MCWDFO with a stepwise increment of one-degree varisation (1°-15°) was performed on 3D surface models of 14 lower extremities with valgus malalignment and 24 lower extremities with neutral alignment of the lower limb, resulting in a total of 608 simulations. Anatomic landmarks were employed to measure hip-knee-ankle angle (HKA), TTTG, and femoral torsion for each simulation. A mathematical formula was adopted to calculate TTTG changes following MCWDFO, and subsequently the mean simulated and calculated TTTG values were compared. Following a standardised protocol, MCWDFO was performed without rotational changes. RESULTS MCWDFO exhibited an almost linear reduction in TTTG, at a rate of approximately -1.05 ± 0.13 mm per 1° of varisation, demonstrating a strong negative correlation (R = -0.83; p < 0.001). Limb alignment did not exert an influence on TTTG change; however, it correlated with tibial plateau width. The mean difference between the simulated and calculated TTTG values amounted to 0.03 ± 0.03 mm per 1° varisation (p < 0.001). CONCLUSION The TTTG distance is linearly reduced by 1.05 mm for every 1° of varisation within the varus correction range of 0°-15° during MCWDFO. Patients with combined valgus and patellar instability may benefit from MCWDFO due to frequently pathological TTTG. LEVEL OF EVIDENCE Level III, descriptive laboratory study.
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Affiliation(s)
- Julius Watrinet
- Department Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
| | - Maximilian Joergens
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Philipp Blum
- Department Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
| | - Yannick Ehmann
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
| | - Peter Augat
- Department Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
- Insititute for Biomechanics, Paracelsus University Salzburg, Salzburg, Austria
| | - Fabian Stuby
- Department Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
| | - Steffen Schröter
- Department of Orthopedics and Reconstructive Surgery, Diakonie Klinikum GmbH Jung-Stilling-Krankenhaus, Siegen, Germany
| | - Joerg Harrer
- Department of Orthopedics and Traumatology, Helmut-G.Walther Klinikum, Lichtenfels, Germany
| | - Julian Fürmetz
- Department Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
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Peez C, Grosse-Allermann A, Deichsel A, Raschke MJ, Glasbrenner J, Briese T, Wermers J, Herbst E, Kittl C. Additional Plate Fixation of Hinge Fractures After Varisation Distal Femoral Osteotomies Provides Favorable Torsional Stability: A Biomechanical Study. Am J Sports Med 2023; 51:3732-3741. [PMID: 37936394 PMCID: PMC10691291 DOI: 10.1177/03635465231206947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/23/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Hinge fractures are considered risk factors for delayed or nonunion of the osteotomy gap in distal femoral osteotomies (DFOs). Limited evidence exists regarding the treatment of hinge fractures after DFO, which could improve stability and thus bone healing. PURPOSE To (1) examine the effect of hinge fractures on the biomechanical properties of the bone-implant construct, (2) evaluate the biomechanical advantages of an additional fixation of a hinge fracture, and (3) test the biomechanical properties of different types of varisation DFOs. STUDY DESIGN Controlled laboratory study. METHODS A total of 32 fresh-frozen human distal femora equally underwent medial closing wedge DFO or lateral opening wedge DFO using a unilateral locking compression plate. The following conditions were serially tested: (1) preserved hinge; (2) hinge fracture along the osteotomy plane; (3) screw fixation of the hinge fracture; and (4) locking T-plate fixation of the hinge fracture. Using a servo-hydraulic materials testing machine, we subjected each construct to 15 cycles of axial compression (400 N; 20 N/s) and internal and external rotational loads (10 N·m; 0.5 N·m/s) to evaluate the stiffness. The axial and torsional hinge displacement was recorded using a 3-dimensional optical measuring system. Repeated-measures 1-way analysis of variance and post hoc Bonferroni correction were used for multiple comparisons. Statistical significance was set at P < .05. RESULTS Independent from the type of osteotomy, a fractured hinge significantly (P < .001) increased rotational displacement and reduced stiffness of the bone-implant construct, resulting in ≥1.92 mm increased displacement and ≥70% reduced stiffness in each rotational direction, while the axial stiffness remained unchanged. For both procedures, neither a screw nor a plate could restore intact rotational stiffness (P < .01), while only the plate was able to restore intact rotational displacement. However, the plate always performed better compared with the screw, with significantly higher and lower values for stiffness (+38% to +53%; P < .05) and displacement (-55% to -72%; P < .01), respectively, in ≥1 rotational direction. At the same time, the type of osteotomy did not significantly affect axial and torsional stability. CONCLUSION Hinge fractures after medial closing wedge DFO and lateral opening wedge DFO caused decreased bone-implant construct rotational stiffness and increased fracture-site displacement. In contrast, the axial stiffness remained unchanged in the cadaveric model. CLINICAL RELEVANCE When considering an osteosynthesis of a hinge fracture in a DFO, an additional plate fixation was the construct with the highest stiffness and least displacement, which could restore intact hinge rotational displacement.
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Affiliation(s)
- Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Arian Grosse-Allermann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Michael J. Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Thorben Briese
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Jens Wermers
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
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Ismailidis P, Schmid C, Werner J, Nüesch C, Mündermann A, Pagenstert G, Egloff C. Distal femoral osteotomy for the valgus knee: indications, complications, clinical and radiological outcome. Arch Orthop Trauma Surg 2023; 143:6147-6157. [PMID: 37278744 PMCID: PMC10491530 DOI: 10.1007/s00402-023-04923-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/21/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The aim of this study was to describe the indications and technical aspects of medial closing and lateral opening distal femoral osteotomy (MCDFO and LODFO) for patients with a valgus knee and to report clinical and radiological outcomes and complications. METHODS Over 6 years, 28 DFOs (22 MCDFO, 6 LODFO) were performed in 22 Patients. In this cohort study, we retrospectively analyzed clinical and radiological outcome measures as well as complications. RESULTS The median (range) age was 47 (17-63) years, height 1.68 (1.56-1.98) m, body mass 80 (49-105) kg, and body mass index (BMI) 27.4 (18.6-37.0) kg/m2. The clinical follow-up was 21 (7-81) months, the need for total or unicompartmental knee arthroplasty (TKA/UKA) and hardware removal was followed up for 59 (7-108) months postoperatively. Preoperatively, hip-knee-ankle angle (HKA, negative values denote varus) was 7.0 (2.0-13.0)°, mechanical lateral distal femoral angle (mLDFA) was 83.7 (79.9-88.2)°, and mechanical proximal tibial angle (MPTA) was 89.0 (86.6-94.5)°. Postoperatively, HKA was -1.3 (-9.0-1.2)° and mLDFA was 90.8 (87.3-97.3)°. The incidence of minor and major complications was 25% and 14%, the incidence of delayed and nonunion was 18% and 4%, respectively. At the last follow-up, 18% of the patients had pain at rest, 25% during activities of daily living, and 39% during physical activity, and 71% were satisfied with the outcome. 7% of the cases received a TKA/UKA, 71% received a hardware removal. CONCLUSION DFO is a reasonable treatment for lateral osteoarthritis in younger patients to avoid disease progression and the need for an UKA/TKA. However, there is a long rehabilitation time, a considerable risk for complications, and a high need for hardware removal. While many patients experienced symptoms at the long-term follow-up, most were satisfied with the outcome. Appropriate patient information is essential. Level of evidence Level IV, Case Series. Trial registration number NCT04382118, clinicaltrials.gov, May 11, 2020.
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Affiliation(s)
- Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
- Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland.
| | - Corinna Schmid
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Julika Werner
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
- Knee Institute Basel, Clarahof, Clinic of Orthopaedic Surgery, Clarahofweg 19a, 4058, Basel, Switzerland
| | - Christian Egloff
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
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Meisterhans M, Flury A, Zindel C, Zimmermann SM, Vlachopoulos L, Snedeker JG, Fucentese SF. Finite element analysis of medial closing and lateral opening wedge osteotomies of the distal femur in relation to hinge fractures. J Exp Orthop 2023; 10:33. [PMID: 36973592 PMCID: PMC10043162 DOI: 10.1186/s40634-023-00597-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/10/2023] [Indexed: 03/29/2023] Open
Abstract
PURPOSE Intraoperative hinge fractures in distal femur osteotomies represent a risk factor for loss of alignment and non-union. Using finite element analysis, the goal of this study was to investigate the influence of different hinge widths and osteotomy corrections on hinge fractures in medial closed-wedge and lateral open-wedge distal femur osteotomies. METHODS The hinge was located at the proximal margin of adductor tubercle for biplanar lateral open-wedge and at the upper border of the lateral femoral condyle for biplanar medial closed-wedge distal femur osteotomies, corresponding to optimal hinge positions described in literature. Different hinge widths (5, 7.5, 10 mm) were created and the osteotomy correction was opened/closed by 5, 7.5 and 10 mm. Tensile and compressive strain of the hinge was determined in a finite element analysis and compared to the ultimate strain of cortical bone to assess the hinge fracture risk. RESULTS Doubling the correction from 5 to 10 mm increased mean tensile and compressive strain by 50% for lateral open-wedge and 48% for medial closed-wedge osteotomies. A hinge width of 10 mm versus 5 mm showed increased strain in the hinge region of 61% for lateral open-wedge and 32% for medial closed-wedge osteotomies. Medial closed-wedge recorded a higher fracture risk compared to lateral open-wedge osteotomies due to a larger hinge cross-section area (60-67%) for all tested configurations. In case of a 5 mm hinge, medial closed-wedge recorded 71% higher strain in the hinge region compared to lateral open-wedge osteotomies. CONCLUSION Due to morphological features of the medial femoral condyle, finite element analysis suggests that lateral-open wedge osteotomies are the preferable option if larger corrections are intended, as a thicker hinge can remain without an increased hinge fracture risk.
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Affiliation(s)
- Michel Meisterhans
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Andreas Flury
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph Zindel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan M Zimmermann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jess G Snedeker
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Fujita K, Sawaguchi T, Goshima K, Shigemoto K, Iwai S. Influence of lateral hinge fractures on biplanar medial closing-wedge distal femoral osteotomy for valgus knee: a new classification of lateral hinge fracture. Arch Orthop Trauma Surg 2023; 143:1175-1183. [PMID: 34655322 DOI: 10.1007/s00402-021-04212-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The purpose of this study was to examine the influence of lateral hinge fractures in medial closing-wedge distal femoral osteotomy (MCWDFO) on bone union. METHODS Twenty-one patients were followed-up for more than 1 year after MCWDFO. The incidence and type of hinge fracture, as well as the course of bone healing, were investigated. Slow healing was defined as bone union was not obtained until 3 months after surgery. RESULTS Hinge fractures were observed in 12 cases (57%). There were three types of hinge fractures. Type 1: the lateral cortex was completely cut through (4 cases), type 2: the osteotomy line was too proximal (6 cases), and type 3: the hinge point was significantly medial (2 cases). There was a significant difference in the mean correction angles between hinge fracture and no-fracture cases, with the mean angles being 13.8 ± 4.0° and 9.6 ± 3.1°, respectively. Sixty-seven percent (8/12) of cases with hinge fractures developed slow healing. Among the hinge fracture cases, when there was no displacement of the hinge fracture and good contact with the anterior flange, 40% (2/5) of cases developed slow healing. If there was displacement of the hinge or no contact of the anterior flange, 86% (6/7) of cases developed slow healing. In contrast, only 11% (1/9) of subjects who did not have a hinge fracture, developed slow healing. In 67% (6/9) of cases with slow healing, a correction loss of 2° or greater (average: 4.3 degrees valgus) was observed. There were no cases of non-union. Clinical outcomes at 1 year showed no significant difference between the groups with and without hinge fractures. CONCLUSIONS There is a very high risk of hinge fracture in patients undergoing MCWDFO. Hinge fractures often lead to slow healing and a loss of correction. We recommend the endpoint of the distal lateral cortex of the femur as the ideal hinge point for the prevention of hinge fractures. Bone union is obtained slowly in even all hinge fracture cases without revision surgery. Consequently, surgical results are not affected by the occurrence of hinge fracture at 1 year.
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Affiliation(s)
- Kenji Fujita
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan. .,Department of Orthopedic Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa, Ishikawa, 920-8530, Japan.
| | - Takeshi Sawaguchi
- Department of Traumatology, Fukushima Medical University, 1 Hikariga-oka, Fukushima, 960-1295, Japan.,Trauma Reconstruction Center, Shinyurigaoka General Hospital, 255 Furusawa Asao-ku, Kawasaki, Kanazawa, 215-0026, Japan
| | - Kenichi Goshima
- Department of Orthopedic Surgery, Kanazawa Munehiro Hospital, 24-30 Sakura-machi, Kanazawa, Ishikawa, 920-0923, Japan
| | - Kenji Shigemoto
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan
| | - Shintaro Iwai
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan
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Jin X, Jin Y, Yuan J, Li F, Bai C. EFFECT OF HIGH-INTENSITY TRAINING ON BONE MINERAL DENSITY IN BASKETBALL PLAYERS. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329012022_0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction Increasing the bone mineral density of athletes can provide better basic physical conditions for basketball players, prevent fractures caused by osteopenia and reduce the occurrence of serious sports injuries. Objective Explore the effect of high-intensity training on bone mineral density in basketball players. Methods In this experiment, 30 subjects were divided into male and female groups, and high-intensity exercise training was performed for 60 minutes, three times a week, for eight weeks. The relevant indices were measured before and after training, and their data were classified and analyzed. Results High-intensity training can significantly improve the bone mineral density of basketball players, and the increase of bone mineral density of female basketball players is slightly lower than that of male players. In addition, the increase in bone mineral density can comprehensively improve athletes’ muscular strength and physical fitness. Conclusion High-intensity training can improve basketball players’ bone mineral density and sports skills, requiring promoting studies for its popularization in colleges and universities. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.
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Affiliation(s)
- Xia Jin
- Xi’an Jiaotong University, China; Northwest University, China
| | - Yiming Jin
- Nanjing University of Information Science & Technology, China
| | - Jing Yuan
- Xi’an Radio and Television University, China
| | - Fei Li
- Xi’an Jiaotong University, China
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11
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Distalization of hinge site with use of hinge wire reduces hinge fracture rates in closing wedge distal femoral osteotomy. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07286-8. [PMID: 36562809 DOI: 10.1007/s00167-022-07286-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Closing wedge distal femoral osteotomies (CWDFO) are attractive treatment options for unicompartmental knee osteoarthritis with coronal plane deformity. However, it has been traditionally associated with high rates of hinge fracture that can adversely impact recovery and patient outcomes. Appropriate siting of hinge point can be an effective method of reducing the incidence of hinge fractures. This study aims to illustrate a case series of CWDFO with low rates of hinge fracture utilising our preferred hinge point site. METHODS A retrospective study of a cohort of 39 CWDFO was performed between May 2019 and May 2022. Both medial and lateral CWDFO were included. The hinge point in all cases was placed at the level of the inferior margin of the metaphyseal flare, and inferior to the gastrocnemius origin, with a hinge thickness of 10 mm. Post-operative radiographs were obtained at 2, 4 and 8 weeks after surgery to assess for hinge fracture and union. RESULTS Thirty-nine cases of CWDFO were performed, consisting of eighteen cases of valgus malalignment that underwent medial CWDFO and twenty-one cases of varus malalignment that underwent lateral CWDFO. At surgery, the mean age was 47.6 (± 13.9) years and mean BMI was 29.4 (± 4.9). There were 23 men and 16 women. Three cases of hinge fractures occurred intraoperatively, translating into a hinge fracture rate of 7.69%. However, union was achieved in all three cases and all patients in this case series were able to progress to weight bear as tolerated at 2 months post-osteotomy. CONCLUSION Distal placement of the hinge at the level of the inferior metaphyseal flare margin with the use of a hinge wire can greatly reduce the rates of hinge fracture in CWDFO. LEVEL OF EVIDENCE Level III.
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12
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Oda T, Maeyama A, Yoshimura I, Ishimatsu T, Miyazaki K, Tachibana K, Yoshimitsu K, Yamamoto T. Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical study. BMC Musculoskelet Disord 2022; 23:1105. [PMID: 36536365 PMCID: PMC9761968 DOI: 10.1186/s12891-022-06078-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Soft tissue has an important role in stabilizing the hinge point of medial closed wedge distal femoral osteotomy (MCWDFO). However, there are conflicting data on the soft tissue anatomy around the hinge point of MCWDFO and, therefore, further anatomical data are needed. The purposes of the study were to: 1) anatomically analyze the soft tissue around the hinge point of MCWDFO; 2) radiologically define the appropriate hinge point to prevent an unstable hinge fracture based on the result of the anatomical analysis; and 3) histologically analyze the soft tissue based on the result of the anatomical analysis. METHODS In 20 cadaveric knees, the capsule attachment of the distal lateral side of the femur was marked with a radiopaque ball bearing. A digital planning tool was used to calculate the area of the marked capsule attachment around the ideal hinge point of MCWDFO on radiographs. The soft tissue around the hinge point was histologically examined and the periosteal thickness was measured and visualized graphically. The graph and radiograph were overlayed using image editing software, and the appropriate hinge position was determined based on the periosteal thickness. RESULTS As a result, the periosteal thickness of the distal lateral femur tended to rapidly decrease from the metaphyseal region toward the diaphyseal region. The overlayed graph and radiograph revealed that the periosteal thickness changed in the region corresponding to the apex of the turning point of the femoral metaphysis in all cases. CONCLUSIONS In conclusion, the periosteum might support the hinge of MCWDFO within the area surrounded by the apex of the turning point of the femoral metaphysis and the upper border of the posterior part of the lateral femoral condyle.
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Affiliation(s)
- Taiga Oda
- grid.411497.e0000 0001 0672 2176Department of Orthopedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180 Japan
| | - Akira Maeyama
- grid.411497.e0000 0001 0672 2176Department of Orthopedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180 Japan
| | - Ichiro Yoshimura
- grid.411497.e0000 0001 0672 2176Department of Orthopedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180 Japan
| | - Tetsuro Ishimatsu
- grid.411497.e0000 0001 0672 2176Department of Orthopedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180 Japan
| | - Kotaro Miyazaki
- grid.411497.e0000 0001 0672 2176Department of Orthopedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180 Japan
| | - Katsuro Tachibana
- grid.411497.e0000 0001 0672 2176Department of Anatomy Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180 Japan
| | - Kengo Yoshimitsu
- grid.411497.e0000 0001 0672 2176Department of Radiology Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180 Japan
| | - Takuaki Yamamoto
- grid.411497.e0000 0001 0672 2176Department of Orthopedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180 Japan
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Nha KW, Kim HS, Jin DU, Bae JH, Patel JM, Kim SG. Predictive Factors for Lateral Hinge Fracture in Medial Closing Wedge Distal Femoral Osteotomy. Am J Sports Med 2022; 50:3819-3826. [PMID: 36326293 DOI: 10.1177/03635465221131527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Recent studies have reported that lateral hinge fracture (LHF) has a negative effect on bone healing at the osteotomy site after medial closing wedge distal femoral osteotomy (MCDFO). However, limited evidence exists in the literature regarding the predictive factors for LHF in MCDFO. HYPOTHESIS A large medial closing gap and a lateral hinge position in the supracondylar area would increase plain radiography-based and/or computed tomography (CT)-based LHF in MCDFO. STUDY DESIGN Case control study; Level of evidence, 3. METHODS We retrospectively evaluated 67 knees of 53 patients (mean age, 37.4 ± 16.9 years) who underwent MCDFO between May 2009 and June 2021. The surgical indications for MCDFO were genu valgum deformity combined with either lateral compartment osteoarthritis or recurrent patellar dislocation. The presence of LHF was evaluated based on immediate postoperative plain radiography and CT scans. The predictive factors for LHF in MCDFO were investigated using multivariate logistic regression analysis. RESULTS LHFs were identified in 21 knees (31.3%) through plain radiography and in 40 knees (59.7%) through CT. Multivariate logistic regression analysis showed that the medial closing gap and lateral hinge position were predictive factors for plain radiography- and CT-based LHF after MCDFO. Controlling for other variables, we found that an increase in the medial opening gap by 1 mm increased the likelihood of plain radiography-based LHF by a factor of 1.805 (95% CI, 1.291-2.525; P = .001) and CT-based LHF by 1.333 (95% CI, 1.003-1.772; P = .048). Moreover, a lateral hinge position in the supracondylar area increased the likelihood of plain radiography-based LHF by a factor of 9.870 (95% CI, 2.179-44.720; P = .003) and CT-based LHF by 5.686 (95% CI, 1.124-28.754; P = .036). CONCLUSION A large medial closing gap and lateral hinge position in the supracondylar area are associated with LHF in MCDFO. Care should be taken to prevent LHF in MCDFO with a large medial closing gap. Moreover, a lateral hinge position in the supracondylar area should be avoided to decrease the incidence of LHF in MCDFO.
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Affiliation(s)
- Kyung Wook Nha
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Gyeongki-do, Republic of Korea
| | - Hyung Suh Kim
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Gyeongki-do, Republic of Korea
| | - Dong Uk Jin
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea
| | - Ji Hoon Bae
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jaykumar M Patel
- Department of Orthopaedic Surgery, Jay Orthopaedic Hospital and Arthroscopy Centre, Shahibaug, Ahmedabad City, India
| | - Sang-Gyun Kim
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea
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Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Analysis of bone union after medial closing wedge distal femoral osteotomy using a new radiographic scoring system. Arch Orthop Trauma Surg 2022; 142:2303-2312. [PMID: 35676376 DOI: 10.1007/s00402-022-04495-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 05/19/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To compare bone union after medial closing wedge distal femoral osteotomy (MCWDFO) with that after lateral closing wedge distal femoral osteotomy (LCWDFO) using a novel scoring system. MATERIALS AND METHODS The data of 30 patients who received biplanar MCWDFO for valgus knees (MCWDFO group) were retrospectively examined and compared to that of 22 patients (25 knees) who underwent biplanar LCWDFO via a double-level osteotomy (DLO) for varus knees (LCWDFO group). The progression of bone union of the transverse osteotomy plane in the femur was assessed using a newly developed scoring system using radiographs taken immediately after surgery and 3 and 6 months postoperatively. The scoring system is based on a scale of zero to six points with higher scores indicating better bone union. The incidence of hinge fractures was assessed using CT images, and the rates of reoperation were evaluated using medical record data. RESULTS The mean bone union score was significantly lower in the MCWDFO group than in the LCWDFO group 3 months (2.1 ± 1.9 vs. 3.7 ± 1.7, P < 0.01) and 6 months (3.8 ± 2.1 vs 4.9 ± 1.5, P < 0.05) postoperatively. The incidence ratio of hinge fractures was significantly higher in the MCWDFO group than in the LCWDFO group (70.0% vs. 32.0%, P < 0.01). Two patients in the MCWDFO group underwent reoperation for delayed bone union or non-union. CONCLUSION Bone union progression was slower and hinge fractures were more frequently observed after MCWDFO than after LCWDFO via DLO. MCWDFO is technically challenging, and patients must be monitored closely during and after surgery.
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Affiliation(s)
- Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Akiyoshi Mori
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shu Watanabe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kiminari Kataoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shinya Oka
- Department of Orthopaedic Surgery, Meiwa Hospital, Nishinomiya, Japan
| | - Kyohei Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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15
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Lee YS. Editorial Commentary: Patient-Specific Instrumentation for Knee High Tibial Osteotomy Addresses the Bony but Not the Soft-Tissue Aspect of Deformity Correction. Arthroscopy 2022; 38:2759-2760. [PMID: 36064281 DOI: 10.1016/j.arthro.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 02/02/2023]
Abstract
Both bony and soft-tissue components should be considered during preoperative planning and intraoperative performance of knee high tibial osteotomy to achieve accurate correction. 3D-printed patient-specific instrumentation may aid in addressing the bony component. Even with appropriate preoperative planning for bony and soft-tissue correction, appropriate adjustments must be made intraoperatively to achieve successful outcomes, and accurate correction is impossible unless the soft-tissue component is considered.
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Affiliation(s)
- Yong Seuk Lee
- Seoul National University College of Medicine, Seoul National University Bundang Hospital
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16
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Liu F, Gao L. THE EFFECT OF SPORTS IN PROMOTING THE ENHANCEMENT OF ADULT BONE DENSITY. REV BRAS MED ESPORTE 2022. [DOI: 10.1590/1517-8692202228022021_0431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: Exercise is an important part of osteoporosis treatment. A moderate amount of exercise can improve bone metabolism, improve bone biomechanics and increase bone density. Objective: To study the effects of different sports on adult bone mineral density. Methods: We selected volunteers to perform different exercises and used quantitative ultrasound and bioelectrical impedance methods to test the volunteers. Results: Exercise can increase the content of lean body mass in body composition and reduce body fat percentage. The calcaneal bone mineral density of physical education students is positively correlated with low body weight. Conclusion: Exercise can promote the bone mineral density of young adults. Stronger weight-bearing exercises can better promote the increase of bone density. Level of evidence II; Therapeutic studies - investigation of treatment results.
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Affiliation(s)
| | - Lulu Gao
- Media University of Henan, China
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17
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Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy. Knee Surg Sports Traumatol Arthrosc 2022; 30:982-992. [PMID: 33638683 PMCID: PMC8901490 DOI: 10.1007/s00167-021-06466-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/19/2021] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the incidence, morphology, and associated complications of medial cortical hinge fractures after lateral closing wedge distal femoral osteotomy (LCW-DFO) for varus malalignment and to identify constitutional and technical factors predisposing for hinge fracture and consecutive complications. METHODS Seventy-nine consecutive patients with a mean age of 47 ± 12 years who underwent LCW-DFO for symptomatic varus malalignment at the authors' institution between 01/2007 and 03/2018 with a minimum of 2-year postoperative time interval were enrolled in this retrospective observational study. Demographic and surgical data were collected. Measurements evaluating the osteotomy cut (length, wedge height, hinge angle) and the location of the hinge (craniocaudal and mediolateral orientation, relation to the adductor tubercle) were conducted on postoperative anterior-posterior knee radiographs and the incidence and morphology of medial cortical hinge fractures was assessed. A risk factor analysis of constitutional and technical factors predisposing for the incidence of a medial cortical hinge fracture and consecutive complications was conducted. RESULTS The incidence of medial cortical hinge fractures was 48%. The most frequent morphological type was an extension fracture type (68%), followed by a proximal (21%) and distal fracture type (11%). An increased length of the osteotomy in mm (53.1 ± 10.9 vs. 57.7 ± 9.6; p = 0.049), an increased height of the excised wedge in mm (6.5 ± 1.9 vs. 7.9 ± 3; p = 0.040) as well as a hinge location in the medial sector of an established sector grid (p = 0.049) were shown to significantly predispose for the incidence of a medial cortical hinge fracture. The incidence of malunion after hinge fracture (14%) was significantly increased after mediolateral dislocation of the medial cortical bone > 2 mm (p < 0.05). CONCLUSION Medial cortical hinge fractures after LCW-DFO are a common finding. An increased risk of sustaining a hinge fracture has to be expected with increasing osteotomy wedge height and a hinge position close to the medial cortex. Furthermore, dislocation of a medial hinge fracture > 2 mm was associated with malunion and should, therefore, be avoided. LEVEL OF EVIDENCE Prognostic study; Level IV.
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18
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Nakayama H, Kanto R, Onishi S, Kambara S, Amai K, Yoshiya S, Schröter S, Tachibana T, Iseki T. Hinge fracture in lateral closed-wedge distal femoral osteotomy in knees undergoing double-level osteotomy: assessment of postoperative change in rotational alignment using CT evaluation. Knee Surg Sports Traumatol Arthrosc 2021; 29:3337-3345. [PMID: 32748235 DOI: 10.1007/s00167-020-06197-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/27/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this study was to examine the radiological features of hinge fracture occurring at the distal medial femoral cortex in knees undergoing biplanar lateral closed-wedge distal femoral osteotomy (LCW-DFO) in double-level osteotomy (DLO) based on pre- and postoperative CT image analyses. It was hypothesised that medial hinge fractures in LCW-DFO would occur with a similar incidence to that in high tibial osteotomy, and its occurrence would affect the clinical/radiological outcomes and induce unintended change in alignment depending on the fracture type (direction of the fracture). METHODS A consecutive series of 36 knees (31 patients) with primary varus osteoarthritis undergoing DLO comprised the study population. The mean age at surgery was 62.0 ± 5.9 years. Presence of hinge fracture was assessed on radiographs and CT images at 1 week. The fracture type was classified depending on the direction of the fracture line: crack propagation in line with the osteotomy (type 1) and fractures extending proximally (type 2) or distally (type 3) from the tip of the wedge. Computer-assisted assessments of bony limb alignment and bony geometry were conducted on a full-length weight-bearing radiograph and CT images using image analysis software. In addition, subjective clinical results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS). Radiological and clinical follow-up results at 1 and 2 years were compared to the preoperative data, while comparative analysis was made between the subjects with and without a hinge fracture. RESULTS Postoperative image examinations revealed type 1 and 2 medial femoral hinge fractures in 4 and 7 knees, while no type 3 fracture was identified in the study population. Consequently, the overall incidence of the hinge fracture was 30.6% (11 of the 36 knees). Four of those 11 fractures (36.4%) could not be detected on plain radiographs. CT image analysis for three-dimensional bony geometry showed greater increase in internal rotation of the distal bony segment (increased femoral antetorsion by 9.5° on average) after surgery compared to the knees without a hinge fracture (P = 0.01). Clinical evaluation using the KOOS at 2 years showed no significant difference between the groups with and without hinge fractures. CONCLUSION In LCW-DFO, medial femoral hinge fractures occurred in 30.6% of the cases. Knees with type 1 hinge fracture exhibited significantly greater increase in femoral antetorsion as compared to those without hinge fracture. In this case series, postoperative weight-bearing protocol was delayed for knees with hinge fracture. Consequently, surgical results were not affected by the occurrence of hinge fracture for up to 2 years. LEVEL OF EVIDENCE IV (case series).
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Affiliation(s)
- Hiroshi Nakayama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan.
| | - Ryo Kanto
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Shintaro Onishi
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Shunichiro Kambara
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, 1-4 Ohama-cho, Nishinomiya, Hyogo, Japan
| | - Kenta Amai
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, 1-4 Ohama-cho, Nishinomiya, Hyogo, Japan
| | - Steffen Schröter
- Diakonie Klinikum Jung-Stilling, Wichernstraße 40, 57074, Siegen, Germany
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Tomoya Iseki
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan
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19
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Winkler PW, Rupp MC, Lutz PM, Geyer S, Forkel P, Imhoff AB, Feucht MJ. A hinge position distal to the adductor tubercle minimizes the risk of hinge fractures in lateral open wedge distal femoral osteotomy. Knee Surg Sports Traumatol Arthrosc 2021; 29:3382-3391. [PMID: 32833073 PMCID: PMC8458183 DOI: 10.1007/s00167-020-06244-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/14/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the incidence and morphology of medial cortical hinge fractures in lateral open wedge distal femoral osteotomy (LOW-DFO) and to determine a safe zone for the position of the osteotomy hinge to minimize the risk of hinge fractures. METHODS Consecutive patients who underwent LOW-DFO for symptomatic valgus malalignment were screened for eligibility for this retrospective observational cohort study. Demographical and surgical data were collected. The incidence and morphology of medial cortical hinge fractures were evaluated on standard postoperative anterior-posterior knee radiographs. Comprehensive measurements evaluating the osteotomy gap and the position of the osteotomy hinge were taken. Additionally, each osteotomy hinge was assigned to a corresponding sector of a proposed five-sector grid of the distal medial femur. RESULTS A total of 100 patients (60% female) with a mean age of 31 ± 13 years were included. The overall incidence of medial cortical hinge fractures was 46% and three distinct fracture types were identified. The most frequently observed fracture type was extension of the osteotomy gap (76%), followed by a proximal (20%) and distal (4%) course of the fracture line in relation to the hinge. Group comparison (hinge fracture vs. no hinge fracture) showed statistically significant higher values for the height of the osteotomy gap (p = 0.001), the wedge angle (p = 0.036), and the vertical distance between the hinge and the proximal margin of the adductor tubercle (AT; p = 0.002) in the hinge fracture group. Furthermore, a significantly lower horizontal distance between the hinge and the medial cortical bone (p = 0.036) was observed in the hinge fracture group. A statistically significant higher incidence of medial cortical hinge fractures was observed when the position of the osteotomy hinge was proximal compared to distal to the proximal margin of the AT (53% vs. 27%; p = 0.023). CONCLUSION Medial cortical hinge fractures in LOW-DFO are a common finding with three distinct fracture types. To minimize the risk of medial cortical hinge fractures, it is recommended to aim for a position of the osteotomy hinge at the level of or distal to the proximal margin of the adductor tubercle. LEVEL OF EVIDENCE Prognostic study; Level III.
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Affiliation(s)
- Philipp W. Winkler
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Marco C. Rupp
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Patricia M. Lutz
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Stephanie Geyer
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Philipp Forkel
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Matthias J. Feucht
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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Kim SC, Kim JS, Yoo HJ, Kim TW, Lee YS. Factors affecting the disparity between preoperative planning and postoperative correction status in distal femoral osteotomy. Knee 2020; 27:1608-1617. [PMID: 33010780 DOI: 10.1016/j.knee.2020.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/09/2020] [Accepted: 08/24/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purposes of this study were to evaluate whether the planning method using the contralateral limb status is reasonable and to determine the disparity between the preoperative planning and actual postoperative correction status by analyzing lateral cortical hinge fractures (LCHFs) in patients who underwent distal femoral osteotomy (DFO). METHODS From 2014 to 2018, 31 cases undergoing DFO were evaluated. The patients were divided into two groups according to two preoperative planning methods. The disparity between the preoperative planning and the postoperative weight-bearing line (WBL) ratio and clinical scores were compared. Analysis was performed to determine the causes of the disparity by evaluating the osteotomy configuration, including that of LCHFs. RESULTS The disparity was observed in the WBL ratio assessment (P < 0.01). In the comparison between two groups, no statistically significant differences were found in the change of WBL ratio (P = 0.78) and postoperative clinical scores. The length of the osteotomy gap was only related to the disparity (R2 = 0.22, P = 0.01), while no statistical significance was found for the regression equation of the displaced LCHF (P > 0.05). The length of the remaining bone between the osteotomy end and opposite cortex was significantly associated with the presence of LCHF (odds ratio, 3.904). CONCLUSIONS The planning method using a contralateral limb status showed similar results to the classical method, but the two methods produced disparity when the degree of correction was increased. LCHF was mostly related to the remaining bone in the medial closing-wedge DFO.
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Affiliation(s)
- Seong Chan Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
| | - Joo Sung Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
| | - Hyun Jin Yoo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, South Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea.
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