Lateral closing wedge distal femoral osteotomy leads to disl
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A Study was conducted to evaluate the incidence, morphology, and associated complications of medial cortical hinge fractures after lateral closing wedge distal femoral osteotomy (LCW-DFO) for varus malalignment and to identify constitutional and technical factors predisposing for hinge fracture and consecutive complications.

79 consecutive patients who underwent LCW-DFO for symptomatic varus malalignment with a minimum of 2-year postoperative time interval were enrolled in this retrospective observational study. Demographic and surgical data were collected. Measurements evaluating the osteotomy cut (length, wedge height, hinge angle) and the location of the hinge (craniocaudal and mediolateral orientation, relation to the adductor tubercle) were conducted on postoperative anterior–posterior knee radiographs and the incidence and morphology of medial cortical hinge fractures was assessed. A risk factor analysis of constitutional and technical factors predisposing for the incidence of a medial cortical hinge fracture and consecutive complications was conducted.

Results:
--The incidence of medial cortical hinge fractures was 48%.

--The most frequent morphological type was an extension fracture type (68%), followed by a proximal (21%) and distal fracture type (11%).

--An increased length of the osteotomy in mm (53.1±10.9 vs. 57.7±9.6), an increased height of the excised wedge in mm (6.5±1.9 vs. 7.9±3) as well as a hinge location in the medial sector of an established sector grid were shown to significantly predispose for the incidence of a medial cortical hinge fracture.

--The incidence of malunion after hinge fracture (14%) was significantly increased after mediolateral dislocation of the medial cortical bone more than 2 mm.

Medial hinge fractures are a common finding after LCW-DFO. There is an increased risk of the fracturing of the hinge at rising wedge height of osteotomy and a hinge near the medial cortex. In addition, the dislocation of a medial hinge fracture more than 2 mm was related to malunion and thus should be avoided.

Source: https://link.springer.com/article/10.1007/s00167-021-06466-2
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