Fixation of Takeuchi Type II/III lateral hinge fractures provides favourable stability of a medial open wedge high tibial osteotomy-A biomechanical study.

IF 3.3 2区 医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-12-15 DOI:10.1002/ksa.12560
Christian Peez, Adrian Deichsel, Ivan Zderic, R Geoff Richards, Ludmil Drenchev, Hristo K Skulev, Boyko Gueorguiev, Michael J Raschke, Christoph Kittl, Elmar Herbst
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Abstract

Purpose: To investigate the biomechanical consequences of osteosynthesis of lateral hinge fractures (LHFs) in medial open wedge high tibial osteotomy (MOWHTO).

Methods: Sixteen fresh-frozen human cadaveric proximal tibiae underwent MOWHTO fixed with an ipsilateral locking compression plate. The specimens were assigned to two clusters simulating LHFs according to the Takeuchi classification: (1) Type II fracture; and (2) Type III fracture. The following conditions were serially tested: (1) intact hinge; (2) fractured hinge; (3) screw fixation of the LHF; (4) staple fixation of the LHF; and (5) locking T-plate fixation of the LHF. Each specimen was subjected to 10 cycles of axial compression load (720 N; 36 N/s), and internal and external rotational loads (10 N m; 1 N m/s), while capturing the interfragmentary movements via motion tracking.

Results: In Takeuchi Type II fractures, osteosynthesis of the fractured hinge with staples or a plate significantly reduced fracture site displacement (p < 0.05) and significantly increased construct stiffness (p < 0.05) under axial and torsional loading, while only the plate restored intact torsional displacement (n.s.). For Takeuchi Type III fractures, both screw and plate fixation significantly reduced fracture site displacement (p < 0.05) and significantly increased construct stiffness (p < 0.05) under axial and torsional loading. Both techniques restored torsional stiffness in each rotational direction and torsional displacement in internal rotation (n.s.).

Conclusion: Additional plate fixation of Takeuchi Type II fractures was the construct with the highest stiffness, restoring the axial and torsional stability to a MOWHTO with an intact hinge. Screw and plate fixation of Takeuchi Type III fractures provided equivalent stability and restored the torsional and axial stability of the MOWHTO. In case of a Takeuchi Type II or III fracture, surgeons should consider additional plate or screw osteosynthesis of the fractured hinge to best restore the stability of the MOWHTO, which may potentially reduce the risk of loss of correction and impaired bone healing.

Level of evidence: There is no level of evidence as this study was an experimental laboratory study.

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Takeuchi II/III 型外侧铰链骨折的固定为内侧开放式楔形高胫骨截骨术提供了良好的稳定性--一项生物力学研究。
目的:探讨内侧开楔形胫骨高位截骨术(MOWHTO)中外侧铰链骨折(LHFs)的生物力学影响。方法:用同侧锁定加压钢板对16例新鲜冷冻人尸体胫骨近端进行MOWHTO固定。根据Takeuchi分类将试件分为2个模拟LHFs簇:(1)II型骨折;(2) III型骨折。对以下条件进行了连续试验:(1)铰链完好;(2)铰链断裂;(3) LHF螺钉固定;(4)短钉固定LHF;(5) LHF锁定t型板固定。每个试件承受10次轴向压缩载荷(720 N;36 N/s),内外旋转载荷(10 N/ m;1 N m/s),同时通过运动跟踪捕捉碎片间的运动。结果:在Takeuchi II型骨折中,用钉钉或钢板固定骨折铰链可显著减少骨折部位移位(p结论:附加钢板固定Takeuchi II型骨折是刚度最高的结构,可恢复完整铰链的轴向和扭转稳定性。Takeuchi III型骨折的螺钉和钢板固定提供了相当的稳定性,并恢复了MOWHTO的扭转和轴向稳定性。对于Takeuchi II型或III型骨折,外科医生应考虑对骨折的铰链进行额外的钢板或螺钉固定,以最好地恢复MOWHTO的稳定性,这可能会潜在地降低矫正丢失和骨愈合受损的风险。证据水平:由于本研究是一项实验性实验室研究,因此没有证据水平。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.10
自引率
18.40%
发文量
418
审稿时长
2 months
期刊介绍: Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).
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