Computational comparison of different plating strategies in medial open-wedge high tibial osteotomy with lateral hinge f
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(2020) 15:409
RESEARCH ARTICLE
Open Access
Computational comparison of different plating strategies in medial open-wedge high tibial osteotomy with lateral hinge fractures Yen-Nien Chen1*† , Chang-Han Chuang2†, Tai-Hua Yang3,4,5,6,7, Chih-Wei Chang4,7*, Chun-Ting Li8, Chia-Jung Chang3 and Chih-Han Chang3,6
Abstract Background: Lateral hinge fracture (LHF) is associated with nonunion and plate breakage in high tibial osteotomy (HTO). Mechanical studies investigating fixation strategies for LHFs to restore stability and avoid plate breakage are absent. This study used computer simulation to compare mechanical stabilities in HTO for different LHFs fixed with medial and bilateral locking plates. Methods: A finite element knee model was created with HTO and three types of LHF, namely T1, T2, and T3 fractures, based on the Takeuchi classification. Either medial plating or bilateral plating was used to fix the HTO with LHFs. Furthermore, the significance of the locking screw at the combi hole (D-hole) of the medial TomoFix plate was evaluated. Results: The osteotomy gap shortening distance increased from 0.53 to 0.76, 0.79, and 0.72 mm after T1, T2, and T3 LHFs, respectively, with medial plating only. Bilateral plating could efficiently restore stability and maintain the osteotomy gap. Furthermore, using the D-hole screw reduced the peak stress on the medial plate by 28.7% (from 495 to 353 MPa), 26.6% (from 470 to 345 MPa), and 32.6% (from 454 to 306 MPa) in T1, T2, and T3 LHFs, respectively. Conclusion: Bilateral plating is a recommended strategy to restore HTO stability in LHFs. Furthermore, using a Dhole locking screw is strongly recommended to reduce the stress on the medial plate for lowering plate breakage risk. Keywords: High tibial osteotomy, Lateral hinge fracture, Plating strategy, Finite element simulation
* Correspondence: [email protected]; [email protected]; [email protected] † Yen-Nien Chen and Chang-Han Chuang contributed equally to this work. 1 Department of Physical Therapy, Asia University, 500, Lioufeng Rd., Wufeng, Taichung 41354, Taiwan 4 Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permissio
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