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. 2018 Jun 1;30(2):171-175.
doi: 10.5792/ksrr.17.034.

Back Out of Locking Pin With Hinge Fracture After High Tibial Osteotomy

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Free PMC article
Case Reports

Back Out of Locking Pin With Hinge Fracture After High Tibial Osteotomy

Shuhei Otsuki et al. Knee Surg Relat Res. .
Free PMC article

Abstract

Low-profile fixation devices for medial opening wedge high tibial osteotomy (OWHTO) were developed in order to avoid skin irritation and additional invasion. However, the low-profile system is associated with additional risks. We report three cases of locking pin back out with the low-profile locking plate system for medial OWHTO.

Keywords: Hinge fracture; Knee; Locking plate; Osteotomy.

Conflict of interest statement

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
(A, B) Preoperative X-rays of a 74-year-old female (case 1). (C, D) X-rays at postoperative week 2. (E, F) Type III hinge fracture in computed tomography. (G) Arthroscopic detection of type III hinge fracture. (H, I) Hinge fracture fixation performed in second surgery.
Fig. 2
Fig. 2
(A, B) Preoperative X-rays of a 65-year-old female (case 2). (C, D) Postoperative X-rays. (E, F) X-rays at postoperative week 2 showing locking pin back out. (G) Type III hinge fracture in computed tomography (arrow).
Fig. 3
Fig. 3
(A, B) A 68-year-old male who underwent opening wedge high tibial osteotomy with a type I fracture. (C) One month after surgery, the locking pin seemed not to have backed out and he could walk with full weight bearing without pain. (D) Two months after surgery, the center pin at the proximal plate backed out. (E, F) The proximal posterior screw was also detected to have backed out without correction loss at 15 months after surgery.
Fig. 4
Fig. 4
(A) Comparison of locking plate systems: TomoFix (DePuy Synthes) and FlexitSystem (Neosteo). The number of threads at the plate and the screw head for the locking system is over 5 in TomoFix, which is larger than that in FlexitSystem. (B) The angle between the plate and the proximal screw was 11° in TomoFix, which was larger than 4° in FlexitSystem. (C) Mechanism of screw deviation with FlexitSystem. The mechanical axis after opening wedge high tibial osteotomy (HTO) passes the lateral eminence of the tibia, which is close to the tip of the locking pin. The large tibial plateau and proximal screw angle (PPSA) with FlexitSystem causes more stress than the small PPSA at the tip of the pin area. Moreover, hinge fracture may induce instability and pin back out.

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