Jesse Chieh-Szu Yang1,2, Philipp Lobenhoffer3, Chia-Ming Chang4,5, Cheng-Fong Chen1,6, Hsiu-Chen Lin4, Hsuan-Hsiao Ma1, Pei-Yuan Lee7,8, Oscar Kuang-Sheng Lee2,9. 1. Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan. 2. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. 3. Sportsclinic Germany, Hannover, Germany. 4. Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan. 5. Department of Physical Therapy and Assistive Technology, National Yang Ming University, Taipei, Taiwan. 6. Department of Orthopedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 7. Orthopedic Department, Show Chwan Memorial Hospital, Changhua, Taiwan. 8. College of Nursing and Health Sciences, DAYEH University, Changhua, Taiwan. 9. Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan.
Abstract
BACKGROUND: The supplemental screw technique was introduced for salvage of lateral hinge fracture in medial open-wedge high tibial osteotomy (owHTO). The efficacy of its use in protection of lateral hinge fracture and corresponding biomechanical behaviors remained unclear. The current study was aimed to clarify if a supplemental screw can provide better protection to lateral hinge in biomechanical perspective. MATERIALS: An in vitro biomechanical test was conducted. Tibial sawbones, commercial owHTO plates and a cannulated screw were utilized for preparing the intact, owHTO, and owHTO with cannulated screw insertion specimens. A "staircase" dynamic load protocol was adopted for axial compressive test with increasing load levels to determine structural strength and durability by using a material testing system, while a motion capture system was applied for determining the dynamic changes in varus angle and posterior slope of the tibia plateau with various specimen preparation conditions. RESULTS: Type II lateral hinge fracture were the major failure pattern in all specimens prepared with owHTO. The insertion of a supplemental cannulated screw in medial owHTO specimens reinforced structural stability and durability in dynamic cyclic loading tests: the compressive stiffness increased to 58.9-62.2% of an intact specimen, whereas the owHTO specimens provided only 23.7-29.2% of stiffness of an intact specimen. In view of tibial plateau alignment, the insertion of a supplemental screw improved the structural deficiency caused by owHTO, and reduced the posterior slope increase and excessive varus deformity by 81.8% and 83.2%, respectively. CONCLUSION: The current study revealed that supplemental screw insertion is a simple and effective technique to improve the structural stability and durability in medial owHTO.
BACKGROUND: The supplemental screw technique was introduced for salvage of lateral hinge fracture in medial open-wedge high tibial osteotomy (owHTO). The efficacy of its use in protection of lateral hinge fracture and corresponding biomechanical behaviors remained unclear. The current study was aimed to clarify if a supplemental screw can provide better protection to lateral hinge in biomechanical perspective. MATERIALS: An in vitro biomechanical test was conducted. Tibial sawbones, commercial owHTO plates and a cannulated screw were utilized for preparing the intact, owHTO, and owHTO with cannulated screw insertion specimens. A "staircase" dynamic load protocol was adopted for axial compressive test with increasing load levels to determine structural strength and durability by using a material testing system, while a motion capture system was applied for determining the dynamic changes in varus angle and posterior slope of the tibia plateau with various specimen preparation conditions. RESULTS: Type II lateral hinge fracture were the major failure pattern in all specimens prepared with owHTO. The insertion of a supplemental cannulated screw in medial owHTO specimens reinforced structural stability and durability in dynamic cyclic loading tests: the compressive stiffness increased to 58.9-62.2% of an intact specimen, whereas the owHTO specimens provided only 23.7-29.2% of stiffness of an intact specimen. In view of tibial plateau alignment, the insertion of a supplemental screw improved the structural deficiency caused by owHTO, and reduced the posterior slope increase and excessive varus deformity by 81.8% and 83.2%, respectively. CONCLUSION: The current study revealed that supplemental screw insertion is a simple and effective technique to improve the structural stability and durability in medial owHTO.
Authors: Catherine Hui; Lucy J Salmon; Alison Kok; Heidi A Williams; Niels Hockers; Willem M van der Tempel; Rishi Chana; Leo A Pinczewski Journal: Am J Sports Med Date: 2010-09-10 Impact factor: 6.202