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, 21 (1), 90-5

A "Safe Zone" in Medial Open-Wedge High Tibia Osteotomy to Prevent Lateral Cortex Fracture

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A "Safe Zone" in Medial Open-Wedge High Tibia Osteotomy to Prevent Lateral Cortex Fracture

Seung Boem Han et al. Knee Surg Sports Traumatol Arthrosc.

Abstract

Purpose: The purpose of this cadaveric study was to study the effect of plane of osteotomy on incidence of lateral cortex fracture and to define a "safe zone" through which medial open-wedge high tibial osteotomy (HTO) could be performed with minimal risk of lateral cortex fracture.

Methods: Medial open HTO was performed in nine fresh frozen human cadavers (18 knees) with each specimen randomly assigned to a "safe zone" osteotomy (group A, between the tip of the fibular head and the circumference line of the fibular head), or a lower level osteotomy (group B, distal to the circumference line of the fibular head).

Results: Six out of nine knees developed lateral cortex fracture in group B compared to none in group A (P = 0.009) when the osteotomy site was distracted to a maximum of 20 mm.

Conclusion: Directing the plane of the osteotomy toward the "safe zone" significantly reduces the risk of lateral cortex fracture compared to an osteotomy, which is directed at a lower level. Confining the plane of a medial open HTO to within the "safe zone" can prevent lateral cortex fracture and subsequent loss of correction.

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