Highlights
- •Hinge fracture in distal femoral osteotomy increased abnormal hinge movements.
- •The increased abnormal movements were reduced by the short support plate.
- •The hinge stability was not significantly improved by a hinge support screw.
- •The short support plate can be an option when a hinge fracture occurs.
Abstract
Background
This study aimed to examine the hinge-stabilizing biomechanical effects of hinge support
fixators, applied for lateral hinge fractures sustained following distal femoral osteotomy.
Methods
Medial closing wedge distal femoral osteotomy was performed using a locking plate
on 10 cadaveric limbs. The limbs were divided into two groups: the non-fracture group
and the lateral hinge fracture group. A cyclic axial load of 400 N was applied to
the knee to keep it extended and flexed at 45°. The hinge-stabilizing effects of adding
a screw or a short support plate to the lateral fracture site were examined by measuring
the translation and rotational angles of the anterodistal and posterodistal hinge
positions as well as the surface strains of the medial locking plate.
Findings
Translation and rotation in the fracture group were significantly more pronounced
than in the non-fracture group, at the anterodistal and posterodistal positions. Translations
at both positions were significantly reduced, by adding the support plate, during
both extension and 45-degree flexion in the fracture group. The rotation at the posterodistal
position upon extension and the anterodistal position upon 45-degree flexion was significantly
reduced by the support plate. The surface strain of the medial plate in the fracture
group was significantly reduced by the support plate upon both extension and 45-degree
flexion.
Interpretation
Lateral hinge fractures caused abnormal hinge movements, which were significantly
reduced by the short support plate. A short support plate could be used if a hinge
fracture occurs during distal femoral osteotomy, to improve lateral hinge stability.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical BiomechanicsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Shear movement at the fracture site delays healing in a diaphyseal fracture model.J. Orthop. Res. 2003; 21: 1011-1017
- Dual plate fixation results in improved union rates in comminuted distal femur fractures compared to single plate fixation.J. Orthop. 2020; 18: 76-79
- Axial and torsional stability of an improved single-plane and a new bi-plane osteotomy technique for supracondylar femur osteotomies.Knee Surg. Sports Traumatol. Arthrosc. 2011; 19: 1090-1098
- Supracondylar femur osteotomies around the knee: patient selection, planning, operative techniques, stability of fixation, and bone healing.Orthopade. 2014; 43: S1-10
- Effects of mechanical factors on the fracture healing process.Clin. Orthop. Relat. Res. 1998; : S132-S147
- Distal femoral varus osteotomy for painful genu valgum. A five-to-11-year follow-up study.Clin. Orthop. Relat. Res. 1993; : 263-269
- Varus osteotomy of the distal part of the femur. A survivorship analysis.J. Bone Joint Surg. Am. 1996; 78: 1348-1352
- Midterm results following medial closed wedge distal femoral osteotomy stabilized with a locking internal fixation device.Knee Surg. Sports Traumatol. Arthrosc. 2015; 23: 2061-2067
- The medial closed-wedge osteotomy of the distal femur for the treatment of unicompartmental lateral osteoarthritis of the knee.Oper. Orthop. Traumatol. 2010; 22: 317-334
- Locking plates for distal femur fractures: is there a problem with fracture healing?.J. Orthop. Trauma. 2011; 25: S8-14
- The influence of cyclic compression and distraction on the healing of experimental tibial fractures.J. Orthop. Res. 2004; 22: 709-715
- Addition of a medial locking plate to an in situ lateral locking plate results in healing of distal femoral nonunions.Clin. Orthop. Relat. Res. 2016; 474: 1498-1505
- Adding a protective screw improves hinge’s axial and torsional stability in High Tibial Osteotomy.Clin. Biomech. 2020; 74: 96-102
- Effect of mechanical stability on fracture healing—an update.Injury. 2007; 38: S3-10
- Factors affecting the disparity between preoperative planning and postoperative correction status in distal femoral osteotomy.Knee. 2020; 27: 1608-1617
- Distal femoral varus osteotomy for lateral osteoarthritis of the knee: a minimum ten-year follow-up.Int. Orthop. 2010; 34: 249-254
- Distal femoral varus osteotomy for valgus deformity of the knee.J. Bone Joint Surg. Am. 1988; 70: 110-116
- Additional fixation of medial plate over the unstable lateral locked plating of distal femur fractures: a biomechanical study.Injury. 2019; 50: 1593-1598
- Distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. A systematic review of the literature.Open Orthop. J. 2012; 6: 313-319
- Ten-year survival rate of 89% after distal femoral osteotomy surgery for lateral compartment osteoarthritis of the knee.Knee Surg. Sports Traumatol. Arthrosc. 2021; 29: 594-599
- A double-plating approach to distal femur fracture: a clinical study.Injury. 2017; 48: 2260-2265
- Distal femoral varus osteotomy for osteoarthritis of the knee.J. Bone Joint Surg. Am. 2005; 87: 127-133
- Distal femoral osteotomy for the valgus knee: medial closing wedge versus lateral opening wedge: a systematic review.Arthroscopy. 2016; 32: 2141-2147
- A supplemental screw enhances the biomechanical stability in medial open-wedge high tibial osteotomy.PLoS One. 2020; 15e0244557
Article Info
Publication History
Published online: November 14, 2021
Accepted:
November 9,
2021
Received:
June 1,
2021
Identification
Copyright
© 2021 Elsevier Ltd. All rights reserved.
