Editorial Commentary: Biomechanical Studies Show Lateral Hinge Screws May Increase Load to Failure After Medial Opening-Wedge High Tibial Osteotomy

Abstract

Lateral hinge fracture is a common complication after medial opening-wedge high tibial osteotomy, occurring in up to 32% to 50% of cases. This can lead to delayed union, nonunion, and loss of correction. A larger medial opening gap width is the most consistently identified risk factor, although lateral hinge width, osteotomy level, and uniplanar versus biplanar technique have also been implicated. To mitigate the risk of postoperative lateral hinge fracture, lateral hinge screws, inserted after osteotomy fixation, have been proposed. Biomechanical studies suggest these improve the ultimate strength of the osteotomy construct, with load to failure increasing 30% in response to varus loading and 2- to 3-fold in response to compressive stress. Despite these biomechanical findings, clinical translation remains a critical next step.