A supplemental screw enhances the biomechanical stability in medial open-wedge high tibial osteotomy.
<h4>Background</h4>The supplemental screw technique was introduced for salvage of lateral hinge fracture in medial open-wedge high tibial osteotomy (owHTO). The efficacy of its use in protection of lateral hinge fracture and corresponding biomechanical behaviors remained unclear. The cur...
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doaj-4603c892a1bb4f02b3ca7504fb74de202021-03-21T05:31:01ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-011512e024455710.1371/journal.pone.0244557A supplemental screw enhances the biomechanical stability in medial open-wedge high tibial osteotomy.Jesse Chieh-Szu YangPhilipp LobenhofferChia-Ming ChangCheng-Fong ChenHsiu-Chen LinHsuan-Hsiao MaPei-Yuan LeeOscar Kuang-Sheng Lee<h4>Background</h4>The supplemental screw technique was introduced for salvage of lateral hinge fracture in medial open-wedge high tibial osteotomy (owHTO). The efficacy of its use in protection of lateral hinge fracture and corresponding biomechanical behaviors remained unclear. The current study was aimed to clarify if a supplemental screw can provide better protection to lateral hinge in biomechanical perspective.<h4>Materials</h4>An in vitro biomechanical test was conducted. Tibial sawbones, commercial owHTO plates and a cannulated screw were utilized for preparing the intact, owHTO, and owHTO with cannulated screw insertion specimens. A "staircase" dynamic load protocol was adopted for axial compressive test with increasing load levels to determine structural strength and durability by using a material testing system, while a motion capture system was applied for determining the dynamic changes in varus angle and posterior slope of the tibia plateau with various specimen preparation conditions.<h4>Results</h4>Type II lateral hinge fracture were the major failure pattern in all specimens prepared with owHTO. The insertion of a supplemental cannulated screw in medial owHTO specimens reinforced structural stability and durability in dynamic cyclic loading tests: the compressive stiffness increased to 58.9-62.2% of an intact specimen, whereas the owHTO specimens provided only 23.7-29.2% of stiffness of an intact specimen. In view of tibial plateau alignment, the insertion of a supplemental screw improved the structural deficiency caused by owHTO, and reduced the posterior slope increase and excessive varus deformity by 81.8% and 83.2%, respectively.<h4>Conclusion</h4>The current study revealed that supplemental screw insertion is a simple and effective technique to improve the structural stability and durability in medial owHTO.https://doi.org/10.1371/journal.pone.0244557 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jesse Chieh-Szu Yang Philipp Lobenhoffer Chia-Ming Chang Cheng-Fong Chen Hsiu-Chen Lin Hsuan-Hsiao Ma Pei-Yuan Lee Oscar Kuang-Sheng Lee |
spellingShingle |
Jesse Chieh-Szu Yang Philipp Lobenhoffer Chia-Ming Chang Cheng-Fong Chen Hsiu-Chen Lin Hsuan-Hsiao Ma Pei-Yuan Lee Oscar Kuang-Sheng Lee A supplemental screw enhances the biomechanical stability in medial open-wedge high tibial osteotomy. PLoS ONE |
author_facet |
Jesse Chieh-Szu Yang Philipp Lobenhoffer Chia-Ming Chang Cheng-Fong Chen Hsiu-Chen Lin Hsuan-Hsiao Ma Pei-Yuan Lee Oscar Kuang-Sheng Lee |
author_sort |
Jesse Chieh-Szu Yang |
title |
A supplemental screw enhances the biomechanical stability in medial open-wedge high tibial osteotomy. |
title_short |
A supplemental screw enhances the biomechanical stability in medial open-wedge high tibial osteotomy. |
title_full |
A supplemental screw enhances the biomechanical stability in medial open-wedge high tibial osteotomy. |
title_fullStr |
A supplemental screw enhances the biomechanical stability in medial open-wedge high tibial osteotomy. |
title_full_unstemmed |
A supplemental screw enhances the biomechanical stability in medial open-wedge high tibial osteotomy. |
title_sort |
supplemental screw enhances the biomechanical stability in medial open-wedge high tibial osteotomy. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2020-01-01 |
description |
<h4>Background</h4>The supplemental screw technique was introduced for salvage of lateral hinge fracture in medial open-wedge high tibial osteotomy (owHTO). The efficacy of its use in protection of lateral hinge fracture and corresponding biomechanical behaviors remained unclear. The current study was aimed to clarify if a supplemental screw can provide better protection to lateral hinge in biomechanical perspective.<h4>Materials</h4>An in vitro biomechanical test was conducted. Tibial sawbones, commercial owHTO plates and a cannulated screw were utilized for preparing the intact, owHTO, and owHTO with cannulated screw insertion specimens. A "staircase" dynamic load protocol was adopted for axial compressive test with increasing load levels to determine structural strength and durability by using a material testing system, while a motion capture system was applied for determining the dynamic changes in varus angle and posterior slope of the tibia plateau with various specimen preparation conditions.<h4>Results</h4>Type II lateral hinge fracture were the major failure pattern in all specimens prepared with owHTO. The insertion of a supplemental cannulated screw in medial owHTO specimens reinforced structural stability and durability in dynamic cyclic loading tests: the compressive stiffness increased to 58.9-62.2% of an intact specimen, whereas the owHTO specimens provided only 23.7-29.2% of stiffness of an intact specimen. In view of tibial plateau alignment, the insertion of a supplemental screw improved the structural deficiency caused by owHTO, and reduced the posterior slope increase and excessive varus deformity by 81.8% and 83.2%, respectively.<h4>Conclusion</h4>The current study revealed that supplemental screw insertion is a simple and effective technique to improve the structural stability and durability in medial owHTO. |
url |
https://doi.org/10.1371/journal.pone.0244557 |
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