Rene Burchard1,2,3, Denise Katerla4,5, Marina Hammer6, Anke Pahlkötter4, Christian Soost7, Gerhard Dietrich6, Arne Ohrndorf6, Wolfgang Richter6, Markus Lengsfeld8, Hans-Jürgen Christ6, Jan Adriaan Graw9,10, Claus-Peter Fritzen6. 1. Department of Trauma and Orthopaedic Surgery, Kreisklinikum Siegen, Weidenauer Str. 76, 57076, Siegen, Germany. rene.burchard@uni-wh.de. 2. Department of Health, University of Witten/Herdecke, Witten, Germany. rene.burchard@uni-wh.de. 3. School of Science and Technology, University of Siegen, Siegen, Germany. rene.burchard@uni-wh.de. 4. Department of Trauma and Orthopaedic Surgery, Kreisklinikum Siegen, Weidenauer Str. 76, 57076, Siegen, Germany. 5. Department of Trauma Surgery, Landeskrankenhaus Bregenz, Carl-Pedenz-Strasse 2, 6900, Bregenz, Austria. 6. Department of Mechanical Engineering, University of Siegen, Paul-Bonatz-Str. 9-11, 57076, Siegen, Germany. 7. Department of Statistics and Econometrics, University of Siegen, Kohlbettstr. 15, 57072, Siegen, Germany. 8. Orthopädie Rhein-Nahe Partnergesellschaft, Eibinger Str. 9, 65385, Rüdesheim, Germany. 9. Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Platz 1, 13353, Berlin, Germany. 10. Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
Abstract
PURPOSE: Opening wedge high tibial osteotomy (HTO) as a treatment in unicompartimental osteoarthritis of the knee can significantly relieve pain and prevent or at least delay an early joint replacement. The fixation of the osteotomy has undergone development and refinements during the last years. The angle-stable plate fixator is currently one of the most commonly used plates in HTOs. The angular stable fixation between screws and the plate offers a high primary stability to retain the correction with early weight-bearing protocols. This surgical technique is performed as a standard of care and generally well tolerated by the patients. Nevertheless, some studies observed that many patients complained about discomfort related to the implant. METHODS: Therefore, the stability of two different intramedullary nails, a short implant used in humeral fractures and a long device used in tibial fractures for stabilization in valgus HTOs, was investigated as an alternative fixation technique. The plate fixator was defined as reference standard. Nine synthetic tibia models were standardly osteotomized and stabilized by one of the fixation devices. Axial compression was realized using a special testing machine and two protocols were performed: a multi-step fatigue test and a load-to-failure test. RESULTS: Overall motion, medial, and lateral displacements were documented. Fractures always occurred at the lateral cortex. Axial cyclic loading up to 800 N was tolerated by all implants without failure. The tibia nail provided highest fatigue strength under the load-to-failure conditions. CONCLUSIONS: The results suggest that intramedullary nailing might be used as an alternative concept in HTO.
PURPOSE: Opening wedge high tibial osteotomy (HTO) as a treatment in unicompartimental osteoarthritis of the knee can significantly relieve pain and prevent or at least delay an early joint replacement. The fixation of the osteotomy has undergone development and refinements during the last years. The angle-stable plate fixator is currently one of the most commonly used plates in HTOs. The angular stable fixation between screws and the plate offers a high primary stability to retain the correction with early weight-bearing protocols. This surgical technique is performed as a standard of care and generally well tolerated by the patients. Nevertheless, some studies observed that many patients complained about discomfort related to the implant. METHODS: Therefore, the stability of two different intramedullary nails, a short implant used in humeral fractures and a long device used in tibial fractures for stabilization in valgus HTOs, was investigated as an alternative fixation technique. The plate fixator was defined as reference standard. Nine synthetic tibia models were standardly osteotomized and stabilized by one of the fixation devices. Axial compression was realized using a special testing machine and two protocols were performed: a multi-step fatigue test and a load-to-failure test. RESULTS: Overall motion, medial, and lateral displacements were documented. Fractures always occurred at the lateral cortex. Axial cyclic loading up to 800 N was tolerated by all implants without failure. The tibia nail provided highest fatigue strength under the load-to-failure conditions. CONCLUSIONS: The results suggest that intramedullary nailing might be used as an alternative concept in HTO.
Authors: Philipp Niemeyer; Hagen Schmal; Oliver Hauschild; Johanna von Heyden; Norbert P Südkamp; Wolfgang Köstler Journal: Arthroscopy Date: 2010-12 Impact factor: 4.772
Authors: Pedro José Labronici; Robinson Esteves Santos Pires; José Sérgio Franco; Hélio Jorge Alvachian Fernandes; Fernando Baldy Dos Reis Journal: Patient Saf Surg Date: 2011-12-01