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J Knee Surg 2019; 32(03): 274-279
DOI: 10.1055/s-0038-1641144
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Where is the Target Point to Prevent Cortical Hinge Fracture in Medial Closing-Wedge Distal Femoral Varus Osteotomy?

Kyung-Wook Nha
1   Department of Orthopaedic Surgery, IIsan Paik Hospital, Inje University, Goyang, Republic of Korea
,
Yong Suk Chang
1   Department of Orthopaedic Surgery, IIsan Paik Hospital, Inje University, Goyang, Republic of Korea
,
Oog-Jin Shon
2   Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
,
Bum-Jin Shim
2   Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
,
Jong Seong Lee
1   Department of Orthopaedic Surgery, IIsan Paik Hospital, Inje University, Goyang, Republic of Korea
,
Jun Seop Song
3   Department of Orthopaedic Surgery, JS Hospital, Seoul, Republic of Korea
,
Ji-Hoon Bae
4   Department of Orthopaedic Surgery, Korea University Guro Hospital, Gurogu, Seoul, Republic of Korea
› Author Affiliations
Further Information

Publication History

16 September 2017

25 February 2018

Publication Date:
04 April 2018 (online)

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Abstract

The purpose of this study was to investigate whether the location of the hinge affects the incidence of hinge fracture during medial closing-wedge distal femoral varus osteotomy (DFVO). Twenty knees from 10 fresh-frozen human cadavers (mean age, 75 ± 17 years) were used to perform uniplanar medial closing-wedge DFVO with a 7-mm wedge. Each specimen was randomly assigned to either group A (supracondylar hinge) or group B (lateral condylar hinge). The incidence of hinge fracture and stability was compared between both groups after uniplanar medial closing-wedge DFVO. In group A, 8 of 10 knees had a lateral cortex fracture during closure of the osteotomy gap, and all fractured knees were unstable. Two knees with an intact lateral cortical hinge showed stability under manual valgus and varus forces. After intentional breakage of the lateral cortical hinge, both knees were found to be unstable under the same force. In group B, 2 of 10 knees had a lateral cortex fracture, and 8 knees had no fractures. All specimens were found to be stable under manual valgus and varus forces. After intentional breakage of the lateral cortical hinge in group B, 2 knees were unstable, while 8 knees remained stable. This study showed a significantly higher incidence of lateral cortical hinge fracture and instability in group A than in group B during closure of the osteotomy gap.

Keywords

femur - knee - osteotomy - hinge fracture - osteoarthritis
 

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