Tanaka Atsuki, Araki Daisuke, Yamashita Takahiro, Sano Shohei, Okada Ryo, Takahashi Mitsuhiko, Hashimoto Yasushi
Department of Orthopaedic Surgery Hyogo Prefectural Rehabilitation Central Hospital Kobe Japan.
Department of Orthopaedic Surgery Kobe University Graduate School of Medicine Kobe Japan.
J Exp Orthop. 2025 May 19;12(2):e70278. doi: 10.1002/jeo2.70278. eCollection 2025 Apr.
Open wedge distal tuberosity tibial osteotomy (owDTO) is an effective treatment for varus knee osteoarthritis. Hinge fracture is a major complication, and hinge position is a contributing factor. This study aimed to investigate the relationship between hinge position and fractures.
This study examined 42 knees that underwent owDTO. The level of the proximal tibiofibular joint (PTFJ) hinge fracture was investigated on postoperative computed tomography (CT) images measuring the distances and angles around hinge area. Based on previous reports, the hinge position was classified, and hinge fractures were assessed.
No cases were found with a hinge position above PTFJ, 41 cases were within PTFJ, and one case was distal to PTFJ. Hinge fractures were observed in 10 patients (23.8%). According to the hinge position classification, seven cases were type I (a fracture within PTFJ), three were type II (a fracture that reaches the distal portion of PTFJ), and no cases were type III (intra-articular fracture). The anteroposterior hinge width measured perpendicular to the descending cut of the flange on axial CT images at the proximal level of the PTFJ was significantly shorter in the hinge fracture group ( = 0.03).
The owDTO hinge fracture rate in our study was comparable to that in previous reports on open wedge high tibial osteotomy. As the risk of hinge fracture increases with the shortening of the anterior-posterior hinge width, our results indicate that preservation of the anterior-posterior hinge width may help reduce hinge fractures.
Level III, Retrospective study.
开放性楔形胫骨远端结节截骨术（owDTO）是治疗膝内翻型骨关节炎的有效方法。铰链骨折是主要并发症，铰链位置是一个影响因素。本研究旨在探讨铰链位置与骨折之间的关系。
本研究检查了42例行owDTO的膝关节。通过术后计算机断层扫描（CT）图像测量铰链区域周围的距离和角度，研究胫腓近端关节（PTFJ）铰链骨折的水平。根据既往报道对铰链位置进行分类，并评估铰链骨折情况。
未发现铰链位置高于PTFJ的病例，41例在PTFJ内，1例在PTFJ远端。10例患者（23.8%）观察到铰链骨折。根据铰链位置分类，7例为I型（PTFJ内骨折），3例为II型（骨折延伸至PTFJ远端部分），无III型（关节内骨折）病例。在PTFJ近端水平的轴向CT图像上，垂直于凸缘下行切口测量的前后铰链宽度在铰链骨折组明显更短（=0.03）。
本研究中owDTO的铰链骨折发生率与既往开放性楔形高位胫骨截骨术的报道相当。由于铰链骨折的风险随着前后铰链宽度的缩短而增加，我们的结果表明保留前后铰链宽度可能有助于减少铰链骨折。
III级，回顾性研究。
