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Review
. 2023 Jul 3;8(7):572-580.
doi: 10.1530/EOR-22-0103.

Lateral hinge fracture in medial opening wedge high tibial osteotomy: a narrative review

Nicolás Franulic  1   2 , José Tomas Muñoz  3 , Francisco Figueroa  4   5 , Piero Innocenti  1 , Nicolás Gaggero  1
Affiliations
Review

Lateral hinge fracture in medial opening wedge high tibial osteotomy: a narrative review

Nicolás Franulic et al. EFORT Open Rev. .

Abstract

Lateral hinge fractures (LHF) are one of the most common complications of medial opening wedge high tibial osteotomy (MOWHTO), and are the leading cause of construct instability displacement, non-union, and varus recurrence after this procedure. To date, Takeuchi's classification is the most popular classification to describe this complication, and it can help surgeons to make intra and postoperative decisions. Opening medial gap width is the most recognized factor related to LHF occurrence. Recognizing the implications of LHF in patients' clinical and radiographic results has led many authors to propose surgical tips and the use of osteosynthesis materials such as K-wires and screws for its prevention, which should be considered when identifying risk factors for LHF during preoperative planning. The evidence for determining the optimal management of LHF is scarce and mostly supported by experts' opinions and recommendations; therefore, studies are still needed to identify the most appropriate behavior when dealing with such a complication.

Keywords: knee; lateral hinge fractures; medial opening wedge high tibial osteotomy.

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Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceivedas prejudicing the impartiality of the research reported.

Figures

Figure 1
Figure 1
Takeuchi´s Classification. Left: Type I fractures extend throughout the osteotomy line and continue through the lateral cortex proximal or at the same level as the proximal tibiofibular joint. Right: Type II fractures extend distal to the proximal tibiofibular joint and Type III fractures extends into the lateral tibial plateau..
Figure 2
Figure 2
A K-wire is positioned intersecting the cutting plane at the theoretical location of the lateral hinge, acting as a mechanical restraint, and reducing the risk of lateral hinge fracture.
Figure 3
Figure 3
Author’s lateral hinge fracture management algorithm. LHF: lateral hinge fracture. WB: weight bearing. NWB: Non weight bearing.
See this image and copyright information in PMC

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