Open AccessA supplemental screw enhances the biomechanical stability in medial open-wedge high tibial osteotomy
Author(s) -
Jesse Chieh Szu Yang,
Philipp Lobenhoffer,
Chia Ming Chang,
Cheng-Fong Chen,
Hsiung Cheng Lin,
Hsuan Hsiao,
Pei Yuan Lee,
Oscar K. Lee
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0244557
Subject(s) - high tibial osteotomy , tibia , materials science , stiffness , hinge , wedge (geometry) , osteotomy , orthodontics , biomedical engineering , medicine , composite material , structural engineering , surgery , osteoarthritis , alternative medicine , physics , optics , pathology , engineering
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.