title: Open-wedge high tibial osteotomy: incidence of lateral cortex fractures and influence of fixation device on osteotomy healing.
abstract: OBJECTIVE
  Open-wedge high tibial osteotomy (HTO) is an established treatment for young and middle-aged patients with medial compartment knee osteoarthritis and varus malalignment. Although not intended, a lateral cortex fracture might occur during this procedure. Different fixation devices are available to repair such fractures. This study was performed to evaluate osteotomy healing after fixation with two different locking plates.
  
  
  METHODS
  Sixty-nine medial open-wedge HTO without bone grafting were followed until osteotomy healing.
  
  
  RESULTS
  In patients with an intact lateral hinge, no problems were noted with either locking plate. A fracture of the lateral cortex occurred in 21 patients (30.4 %). In ten patients, the fracture was not recognized during surgery but was visible on the radiographs at the 6-week follow-up. Lateral cortex fracture resulted in non-union with the need for surgical treatment in three out of eight (37.5 %) patients using the newly introduced locking plate (Position HTO Maxi Plate), while this did not occur with a well-established locking plate (TomoFix) (0 out of 13, p = 0.023).
  
  
  CONCLUSIONS
  With regard to other adverse events, no differences between both implants were observed. In cases of lateral cortex fracture, fixation with a smaller locking plate resulted in a relevant number of non-unions. Therefore, it is recommended that bone grafting, another fixation system, or an additional lateral fixation should be used in cases with lateral cortex fracture.
  
  
  METHODS
  III.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University Hospital Carl Gustav Carus, Medical Faculty of the Technical University of Dresden, Fetscherstr. 74, 01307, Dresden, Germany. Julian.dexel@uniklinikum-dresden.de.
authors.forename: Julian
authors.initials: J
authors.lastname: Dexel
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University Hospital Carl Gustav Carus, Medical Faculty of the Technical University of Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
authors.forename: Hagen
authors.initials: H
authors.lastname: Fritzsche
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University Hospital Carl Gustav Carus, Medical Faculty of the Technical University of Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Beyer
authors.affiliation: Department of Bioengineering, Clemson University, Clemson, SC, USA.
authors.forename: Melinda K
authors.initials: MK
authors.lastname: Harman
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University Hospital Carl Gustav Carus, Medical Faculty of the Technical University of Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Lützner
mesh_terms: D000293:Adolescent; D000328:Adult; D001860:Bone Plates / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D016268:Internal Fixators; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D017063:Outcome Assessment, Health Care; D011859:Radiography; D011795:Surveys and Questionnaires; D013977:Tibia / Q000601:surgery*; D013978:Tibial Fractures / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D014945:Wound Healing; D055815:Young Adult
keywords: Complications; High tibial osteotomy; Position HTO Maxi Plate; Results; TomoFix