Abstract
BackgroundThe neurovascular bundle containing the deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy (OWHTO), particularly due to drilling for bicortical fixation at distal screw holes. Therefore, monocortical fixation is recommended for distal fixation of a long locking plate as long as good stability is ensured. The purpose of this study was to analyse the biomechanical properties of monocortical fixation of distal locking screws for OWHTO.MethodsThree-dimensional models of bone and fixation materials simulating OWHTO were created using computed tomographic data of patients and material data of a T-shaped long locking plate and screws. Three of the four distal screws of the locking plate were chosen for a bicortical fixation or monocortical fixation procedure. In addition, loss of correction was assessed by measuring the medial proximal tibial angle (MPTA) in patients who underwent OWHTO with two bicortical and two monocortical distal fixation screws at 1 month and 1 year after surgery.ResultsNo significant differences in stress were observed in either the normal or osteoporotic bone model between the monocortical and bicortical fixation models, including in the area of the lateral hinge at the osteotomy site.Furthermore, there were no significant differences in MPTA between the early post-operative period and 1-year follow-up.ConclusionsThe monocortical fixation method for three distal screws of the locking plate did not worsen the mechanical properties of fixation for OWHTO using a long locking plate with four proximal and four distal screws. In actual surgery, the number of distal bicortical screws should be reduced based on the patient’s condition, taking into account the risk of lateral hinge fracture and unexpected surgical complications. Using at least two bicortical screws would be practical considering the various factors related to reduced fixing ability.
Highlights
Open-wedge high tibial osteotomy (OWHTO) is an effective procedure for treating medial osteoarthritis of the knee with varus deformity
Loss of correction was assessed by measuring the medial proximal tibial angle (MPTA) in 34 patients who underwent open-wedge high tibial osteotomy (OWHTO) in which monocortical and bicortical fixation were used for each of two distal screws at 1 month and 1 year after surgery
The value of the equivalent stress in bone at 4) the lateral hinge indicated that lateral hinge fracture was highly unlikely (Figs. 6 and 7; Tables 2 and 3)
Summary
Open-wedge high tibial osteotomy (OWHTO) is an effective procedure for treating medial osteoarthritis of the knee with varus deformity. OWHTO has been widely performed since good clinical results were first reported for innovative surgical procedures utilising biplanar osteotomy and locking plate fixation [1]. Special long locking plates, such as the TomoFix® (Johnson & Johnson, West Chester, PA), are known to provide good stability at the osteotomy site enabling early weightbearing after surgery with low risk of loss of correction or impaired bone union. The neurovascular bundle containing the deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy (OWHTO), due to drilling for bicortical fixation at distal screw holes. Monocortical fixation is recommended for distal fixation of a long locking plate as long as good stability is ensured.
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