Peez Christian, Deichsel Adrian, Zderic Ivan, Richards R Geoff, Drenchev Ludmil, Skulev Hristo K, Gueorguiev Boyko, Raschke Michael J, Kittl Christoph, Herbst Elmar
AO Research Institute Davos, Davos, Switzerland.
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany.
Knee Surg Sports Traumatol Arthrosc. 2025 Apr;33(4):1428-1442. doi: 10.1002/ksa.12560. Epub 2024 Dec 15.
To investigate the biomechanical consequences of osteosynthesis of lateral hinge fractures (LHFs) in medial open wedge high tibial osteotomy (MOWHTO).
Sixteen fresh-frozen human cadaveric proximal tibiae underwent MOWHTO fixed with an ipsilateral locking compression plate. The specimens were assigned to two clusters simulating LHFs according to the Takeuchi classification: (1) Type II fracture; and (2) Type III fracture. The following conditions were serially tested: (1) intact hinge; (2) fractured hinge; (3) screw fixation of the LHF; (4) staple fixation of the LHF; and (5) locking T-plate fixation of the LHF. Each specimen was subjected to 10 cycles of axial compression load (720 N; 36 N/s), and internal and external rotational loads (10 N m; 1 N m/s), while capturing the interfragmentary movements via motion tracking.
In Takeuchi Type II fractures, osteosynthesis of the fractured hinge with staples or a plate significantly reduced fracture site displacement (p < 0.05) and significantly increased construct stiffness (p < 0.05) under axial and torsional loading, while only the plate restored intact torsional displacement (n.s.). For Takeuchi Type III fractures, both screw and plate fixation significantly reduced fracture site displacement (p < 0.05) and significantly increased construct stiffness (p < 0.05) under axial and torsional loading. Both techniques restored torsional stiffness in each rotational direction and torsional displacement in internal rotation (n.s.).
Additional plate fixation of Takeuchi Type II fractures was the construct with the highest stiffness, restoring the axial and torsional stability to a MOWHTO with an intact hinge. Screw and plate fixation of Takeuchi Type III fractures provided equivalent stability and restored the torsional and axial stability of the MOWHTO. In case of a Takeuchi Type II or III fracture, surgeons should consider additional plate or screw osteosynthesis of the fractured hinge to best restore the stability of the MOWHTO, which may potentially reduce the risk of loss of correction and impaired bone healing.
There is no level of evidence as this study was an experimental laboratory study.
探讨内侧开放楔形高位胫骨截骨术（MOWHTO）中外侧铰链骨折（LHF）接骨术的生物力学后果。
对16具新鲜冷冻的人体尸体胫骨近端进行MOWHTO，并用同侧锁定加压钢板固定。根据竹内分类法将标本分为两组模拟LHF：（1）II型骨折；（2）III型骨折。依次测试以下情况：（1）完整铰链；（2）骨折铰链；（3）LHF的螺钉固定；（4）LHF的钉板固定；（5）LHF的锁定T形钢板固定。每个标本承受10个周期的轴向压缩载荷（720 N；36 N/s）以及内、外旋转载荷（10 N·m；1 N·m/s），同时通过运动跟踪捕捉骨折块间的运动。
在竹内II型骨折中，用钉板或钢板对骨折铰链进行接骨术可显著减少轴向和扭转载荷下骨折部位的位移（p < 0.05），并显著增加结构刚度（p < 0.05），而只有钢板能恢复完整的扭转位移（无统计学差异）。对于竹内III型骨折，螺钉和钢板固定在轴向和扭转载荷下均显著减少骨折部位的位移（p < 0.05），并显著增加结构刚度（p < 0.05）。两种技术均恢复了每个旋转方向的扭转刚度以及内旋时的扭转位移（无统计学差异）。
竹内II型骨折的附加钢板固定是刚度最高的结构，能恢复铰链完整的MOWHTO的轴向和扭转稳定性。竹内III型骨折的螺钉和钢板固定提供了同等的稳定性，并恢复了MOWHTO的扭转和轴向稳定性。对于竹内II型或III型骨折，外科医生应考虑对骨折铰链进行附加钢板或螺钉接骨术，以最佳地恢复MOWHTO的稳定性，这可能会降低矫正丢失和骨愈合受损的风险。
由于本研究是一项实验性实验室研究，因此不存在证据水平。
