Predictive Factors for and Detection of Lateral Hinge Fractures Following Open Wedge High Tibial Osteotomy: Plain Radiography Versus Computed Tomography

Abstract

PURPOSE: To compare the accuracy of plain radiography and computed tomography (CT) in detecting lateral hinge fractures and to identify predictive factors of the lateral hinge fractures after open wedge high tibial osteotomy (HTO). METHODS: This study included patients who underwent isolated primary open wedge HTO for medial compartment degenerative arthritis from 2015 to 2016 and were evaluated by postoperative CT scans and followed for a minimum of 1 year. This study involved 48 patients (48 knees) undergoing open wedge HTO for primary medial osteoarthritis. Lateral hinge fractures were evaluated on immediate plain radiographs and CT scans according to the Takeuchi classification. Predictive factors of plain radiograph-based hinge fracture and CT-based hinge fracture were investigated. RESULTS: The detection rate of lateral hinge fracture was significantly higher on CT scans than on plain radiographs (50% vs 14.6%; P < .001). Seven knees (14.6%) showed lateral hinge fractures on postoperative plain radiographs, including 6 with type I and 1 with type III fractures; 24 (50.0%) showed lateral hinge fractures on postoperative CT scans, including 20 with type I, 2 with type II, and 2 with type III fractures. CT scans detected 14 type I, 2 type II, and 1 type III hinge fractures not detected by plain radiographs. The medial opening gap width was the only predictor of lateral hinge fracture on CT scans (adjusted odds ratio, 1.565; P =.034). CONCLUSIONS: The incidence of lateral hinge fracture of the knee after open wedge HTO was higher on CT scans than on plain radiographs. The medial opening gap width was the only predictor of lateral hinge fractures, suggesting a need for care when spreading the gap to avoid lateral hinge fractures. LEVEL OF EVIDENCE: Level III, cross-sectional study.