Abstract
Introduction
Medial closed-wedge distal femoral osteotomy (MCWDFO) is a valuable treatment approach for lateral knee osteoarthritis with femoral valgus deformity. Improved results have been reported with the upgrade of surgical techniques and locking plates. However, the risk of nonunion and loss of correction increases in cases of lateral hinge fractures. This study aimed to evaluate the mechanical impact of hinge fractures and support instruments in MCWDFO using finite element analysis (FEA).
Materials and methods
Five femur models were developed using Mechanical Finder 11.0 FEA software. We simulated the following models: only a medial locking plate (MLP) (group A); an MLP with a lateral support screw (group B); and an MLP with a lateral support plate (group C). The equivalent stress around the hinge was evaluated and the percentage of the plastic deformation zone was calculated for the hinge area in the no-hinge fracture model. The equivalent stress of the MLP and the degree of displacement were calculated using the hinge fracture model.
Results
The percentages of the plastic deformation zone in groups A, B, and C were 18.0 ± 11.7%, 3.3 ± 2.4%, and 2.3 ± 2.8%, respectively. The percentages tended to be lower in groups B and C than in group A. In the hinge fracture model, the mean equivalent stress of the MLP in group C was significantly less than that in group A. In terms of the mean degree of displacement, group A showed more than 1 mm of displacement, which was significantly larger than that of the other groups.
Conclusion
The support instruments provided stability to the hinge site and reduced the equivalent stress of the main plate in the MCWDFO with hinge fractures. No significant difference was observed between the two instruments in terms of stability.
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Data, materials, and/or code availability
The datasets used and/or analyzed during the present study are available from the corresponding author upon reasonable request.
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We would like to thank Editage (www.editage.com) for the English language editing.
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This work was jointly funded by the Tokyo Women’s Medical University and Olympus Terumo Biomaterials Corp.
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UK: Conception and design of the study, drafting of the article, data acquisition, analysis, and interpretation. MI: Drafting of the article and critical revision of its contents. JI: Drafting of the article and critical revision of its content. KO: Drafting of the article and critical revision of its contents, as well as approval of the final version to be submitted.
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All procedures involving human participants were conducted in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments. This study was approved by the Institutional Review Board of Tokyo Women’s Medical University (No. 4713-R).
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Kuwashima, U., Itoh, M., Itou, J. et al. Impact of support instruments in medial closed-wedge distal femoral osteotomy: a finite element analysis. Arch Orthop Trauma Surg 144, 1039–1045 (2024). https://doi.org/10.1007/s00402-023-05152-x
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DOI: https://doi.org/10.1007/s00402-023-05152-x