Prediction of Fractures After Open Wedge High Tibial Osteotomy Based on the Distance From the Tibial Osteotomy Point to the Medial Edge of the Tibia

Abstract

Background

To investigate the relationship between the distance from the medial tibial osteotomy point to the medial tibial edge and the development of lateral tibial hinge fracture (type II) and intra-articular tibial plateau fracture (type III) in patients who have degenerative disease undergoing open wedge high tibial osteotomy (OWHTO). This information will aid surgeons in avoiding the occurrence of fractures.

Methods

This retrospective study analyzed 304 patients who underwent OWHTO from January 2018 to January 2024 in the Affiliated Hospital of Qingdao University. The distance from the tibial osteotomy point to the medial tibial edge on imaging was analyzed to determine its association with fracture. A one-way analysis of variance was used to compare the differences in height, weight, body mass index, the distance from the medial tibial osteotomy point to the medial tibial edge, sex, left and right sides of the knee, and osteoporosis in the occurrence of types II and III fractures. Receiver operating characteristic curves were used to identify the critical distances associated with type II and type III fractures. Logistic regression analyses were used to obtain the OR of the critical distance adjusted for age, sex, left and right sides, body mass index, and T value.

Results

There were 40 fractures (13.3%) in 304 patients after OWHTO, comprising 21 type II fractures (7.0%) and 19 type III fractures (6.3%). A single-factor variance analysis showed that the tibial bone cutting distance to the medial tibial edge (P = 0.02) and osteoporosis (P = 0.01) were significantly different from the fracture. Receiver operating characteristic curves showed that the critical distances for types II and III fractures were 40.5 and 47.1 mm, respectively. Logistic regression analysis showed that the ORs [odds ratios] of types II and III fractures were 1.061 (95% CI [confidence interval] = 1.010 to 1.115) and 1.064 (95% CI = 1.011 to 1.119), respectively.

Conclusions

In patients undergoing OWHTO, the risk factors for type II and III fractures are osteoporosis and the distance from the tibial bone cutting point to the medial tibial edge. This distance should be minimized during OWHTO to avoid type II and III fractures.