Opposite cortical fracture in high tibial osteotomy: lateral closing compared to the medial opening‐wedge technique

Figures & data

Table 1.  Baseline characteristics of the total study population and separately for the two intervention groups

	Total (n = 87)	Closing‐wedge HTO (n = 44)	Opening‐wedge HTO (n = 43)
Gender (male / female)	55/32	25/19	30/13
Age in years, mean (SD)	50 (8.6)	50 (8.1)	50 (9.1)
HKA angle ^a in degrees,
mean (SD)	5.9 (3.0)	6.6 (3.1) ^b	5.3 (2.8) ^b
Ahlbäck grade:
medial compartment
0	2	1	1
1	74	39	35
2	11	4	7
lateral compartment
0	80	39	41
1	7	5	2

^a positive angle represents varus alignment; negative angle represents valgus alignment.

^b p = 0.05 for the difference between the two intervention groups.

Figure 1. Closing‐wedge HTO. Opposite cortical fracture on the first day after surgery (radiograph in supine position).

Figure 2. Opening‐wedge HTO. Opposite cortical fracture on the first day after surgery (radiograph in supine position).

Figure 3. Opposite medial cortical fracture with a gap in closing‐wedge HTO on the first day after surgery (radiograph in supine position).

Table 2.  Whole‐leg alignment (HKA angle) for closing‐ and opening‐wedge high tibial osteotomy groups with or without opposite cortical fracture. Values are mean (SD)

	Closing‐wedge HTO (n = 44)		Opening‐wedge HTO (n = 43)
Opposite cortical fracture	yes	no	yes	no
n	36	8	15	28
HKA angle ^a, degrees
preoperatively	6.7 (2.9)	6.0(4.1)	4.9 (3.2)	5.5 (2.5)
postoperatively	−3.2 (3.5)	−2.5 (3.7)	0.9 (6.7) ^b	−2.3 (4.0) ^b

^a positive angle represents varus alignment; negative angle represents valgus alignment.

^b p = 0.06 for postoperative difference in HKA angle with and without cortex disruption in opening‐wedge group.

Table 3.  Whole‐leg alignment (HKA angle) for closing‐wedge osteotomy, stratified according to medial cortex fracture pattern in 36 cases with opposite cortical fracture. Values are mean (SD)

	No gap (n = 18)	Gap (n = 18)	P‐value
HKA angle ^a, degrees
preoperatively	6.1 (2.9)	7.2 (2.9)	0.3
postoperatively	−2.1 (3.4)	−4.3 (3.4)	0.05

^a positive angle represents varus alignment: negative angle represents valgus alignment.