Does Lateral Cortex Fracture in Opening Wedge High Tibial Osteotomy Effects the Distraction Force of Osteotomy Site?
Author(s):
Kaya Bicer Elcil (Turkey)
,
Kaya Bicer Elcil (Turkey)
Affiliations:
Soykan Z.
,
Soykan Z.
Affiliations:
Uzun B.
,
Uzun B.
Affiliations:
Üstün Ç.
,
Üstün Ç.
Affiliations:
Sur N.
,
Sur N.
Affiliations:
Aydogdu S.
Aydogdu S.
Affiliations:
ESSKA Academy. KAYA BICER E. 05/09/18; 209562; P09-1517 Topic: Biomechanics
Elcil KAYA BICER
Elcil KAYA BICER
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Abstract
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Objectives: Objective
An unintended proximal lateral cortical fracture may occur during opening wedge high tibial osteotomy (OWHTO). This study is designed to determine the impact of lateral cortex fracture on the required force for distraction of the ostetotomy site.

Methods: Method
This study is performed on ten fresh frozen human cadavers after taking the local ethical comitee approval. OWHTO is performed on all of the specimens; in five lateral cortex was preserved (LCI) and in the other five lateral cortex is fractured (LCF). For this biomechanical study a custom made distraction force measurement device was produced. In both groups, distraction of osteotomy was performed up to 15 mm and required force for distraction (RFD) was measured in every half milimeter of distraction. RFD values of both groups were compared in between. Statistical analysis was made with R 3.3.0 program and significance level was set at 0,05.

Results: Results
Median values of RFD in 8-15mm of distraction was significantly higher in LCI group (p<0,0001). When the distraction was 8mm median RFD value was 15,85N (range, 10,85-21,3N) in LCI group, 2,1N (range 0,75-7N)(p=0,01) LCF group. Onset RFD values of LCI is eight times higher than LCF. Fracture of the lateral cortex lowers the onset RFD value by %86,7 (p=0,01). In LCI group RFD values increase until 12,5mm of distraction afterwards RFD value stops increasing. In LCI group RFD value for 10mm of distraction is 38,28N and 59,33N for 12,5mm. In LCF onset values of RFD were significantly lower and remain low until 15mm of distraction. RFD values were 4,45N for 10mm of distaction and 5,4N for 12,5mm.

Conclusions: Conclusions
Fracture of the lateral cortex during OWHTO significantly lowers the RFD values at the osteotomy site. This decline shows the lack of stabilizing effect of the lateral cortex. When the lateral cortex is preserved RFD values increase until 12,5mm of distraction then stops increasing and stays the same. When the required correction is bigger than 12,5mm with OWTHO, preservation of the lateral cortex can be challenging. Despite intraopereative fluoroscopic guidance, lateral cortex may unintentionally fracture when performing OWHTO which significantly destabilizes the ostetotomy site and is associated with poor results. In that case, a system that can simultaneously distract the ostetotmy site and measure the force of distraction can be useful to avoid this unpleasant complication

Keywords:
high tibial osteotomy, lateral cortex fracture, osteotomy, cadaver, biomechanical
Objectives: Objective
An unintended proximal lateral cortical fracture may occur during opening wedge high tibial osteotomy (OWHTO). This study is designed to determine the impact of lateral cortex fracture on the required force for distraction of the ostetotomy site.

Methods: Method
This study is performed on ten fresh frozen human cadavers after taking the local ethical comitee approval. OWHTO is performed on all of the specimens; in five lateral cortex was preserved (LCI) and in the other five lateral cortex is fractured (LCF). For this biomechanical study a custom made distraction force measurement device was produced. In both groups, distraction of osteotomy was performed up to 15 mm and required force for distraction (RFD) was measured in every half milimeter of distraction. RFD values of both groups were compared in between. Statistical analysis was made with R 3.3.0 program and significance level was set at 0,05.

Results: Results
Median values of RFD in 8-15mm of distraction was significantly higher in LCI group (p<0,0001). When the distraction was 8mm median RFD value was 15,85N (range, 10,85-21,3N) in LCI group, 2,1N (range 0,75-7N)(p=0,01) LCF group. Onset RFD values of LCI is eight times higher than LCF. Fracture of the lateral cortex lowers the onset RFD value by %86,7 (p=0,01). In LCI group RFD values increase until 12,5mm of distraction afterwards RFD value stops increasing. In LCI group RFD value for 10mm of distraction is 38,28N and 59,33N for 12,5mm. In LCF onset values of RFD were significantly lower and remain low until 15mm of distraction. RFD values were 4,45N for 10mm of distaction and 5,4N for 12,5mm.

Conclusions: Conclusions
Fracture of the lateral cortex during OWHTO significantly lowers the RFD values at the osteotomy site. This decline shows the lack of stabilizing effect of the lateral cortex. When the lateral cortex is preserved RFD values increase until 12,5mm of distraction then stops increasing and stays the same. When the required correction is bigger than 12,5mm with OWTHO, preservation of the lateral cortex can be challenging. Despite intraopereative fluoroscopic guidance, lateral cortex may unintentionally fracture when performing OWHTO which significantly destabilizes the ostetotomy site and is associated with poor results. In that case, a system that can simultaneously distract the ostetotmy site and measure the force of distraction can be useful to avoid this unpleasant complication

Keywords:
high tibial osteotomy, lateral cortex fracture, osteotomy, cadaver, biomechanical
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