Adding a protective screw improves hinge's axial and torsional stability in High Tibial Osteotomy.
Finite element analysis
High Tibial Osteotomy
Hinge protection
Hinge screw
Hinge's fracture
Journal
Clinical biomechanics (Bristol, Avon)
ISSN: 1879-1271
Titre abrégé: Clin Biomech (Bristol, Avon)
Pays: England
ID NLM: 8611877
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
06
10
2019
revised:
25
02
2020
accepted:
27
02
2020
pubmed:
11
3
2020
medline:
20
2
2021
entrez:
11
3
2020
Statut:
ppublish
Résumé
Despite the use of a locking plate a 30% incidence of lateral hinge fracture after Open-Wedge High Tibial Ostetomy was described in the literature. A finite element model was used to analyze if the presence of a hinge-securing screw in the osteotomy area, using Patient Specific Cutting Guides with a locking plate, decreases the stresses within the lateral hinge during compression and torsion. A 3D model of a tibial sawbone was used to simulate an opening wedge of 10°. To apply loads on the tibial plateau, two supports were modelled on each tibial plateau to simulate the femoral condyles forces. A two second model with a hinge-stabilizing was defined with two different screws (diameter 2 mm and 4 mm). Two cases of static charges were considered 1) compression test (2500 N) 2) Torsion test (along the tibial mechanical axis). During compression simulation, 17% of the total surface of lateral hinge was stressed between 41-50Mpa without hinge-securing screw while the amount of surface under stress between 41 and 50 MPa dropped significantly under screw stabilization (1% for the 2 mm and 3% for the 4 mm). During torsion stress simulation a decrease of the value of the maximal stress in the lateral hinge was also observed with the addition of a hinge-securing screw (37 MPa without screw, 27Mpa with a 2 mm screw and 25 Mpa with a 4 mm screw). Positioning a screw intersecting the cutting plane at the theoretical lateral hinge location associated with a locking plate reduces lateral hinge stress in both compression and torsion. Those findings need to be confirmed by further specimens' mechanical testing.
Sections du résumé
BACKGROUNDS
Despite the use of a locking plate a 30% incidence of lateral hinge fracture after Open-Wedge High Tibial Ostetomy was described in the literature. A finite element model was used to analyze if the presence of a hinge-securing screw in the osteotomy area, using Patient Specific Cutting Guides with a locking plate, decreases the stresses within the lateral hinge during compression and torsion.
METHODS
A 3D model of a tibial sawbone was used to simulate an opening wedge of 10°. To apply loads on the tibial plateau, two supports were modelled on each tibial plateau to simulate the femoral condyles forces. A two second model with a hinge-stabilizing was defined with two different screws (diameter 2 mm and 4 mm). Two cases of static charges were considered 1) compression test (2500 N) 2) Torsion test (along the tibial mechanical axis).
FINDINGS
During compression simulation, 17% of the total surface of lateral hinge was stressed between 41-50Mpa without hinge-securing screw while the amount of surface under stress between 41 and 50 MPa dropped significantly under screw stabilization (1% for the 2 mm and 3% for the 4 mm). During torsion stress simulation a decrease of the value of the maximal stress in the lateral hinge was also observed with the addition of a hinge-securing screw (37 MPa without screw, 27Mpa with a 2 mm screw and 25 Mpa with a 4 mm screw).
INTERPRETATION
Positioning a screw intersecting the cutting plane at the theoretical lateral hinge location associated with a locking plate reduces lateral hinge stress in both compression and torsion. Those findings need to be confirmed by further specimens' mechanical testing.
Identifiants
pubmed: 32151903
pii: S0268-0033(20)30079-6
doi: 10.1016/j.clinbiomech.2020.02.015
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
96-102Informations de copyright
Copyright © 2020 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest Christophe Jacquet, Auriane Marret, Robin Myon, Matthieu Ehlinger, Nadia BahloulI, Jean-Marie Rossi: have nothing to declare. Adrian Wilson is consultant for Newclip technologies, arthrex and Stryker. Kristian Kley is consultant for Newclip technologies and Stryker. Sébastien Parratte is consultant for Newclip technologies and Zimmer. Matthieu Ollivier consultant for Newclip technologies, arthrex and Stryker.