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Fibular nonunion after closed-wedge high tibial osteotomy
M Ramanoudjame1, E Vandenbussche, T Baring
1Service de chirurgie orthopédique, université Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, Paris, France. ramanoudjame.mira@yahoo.fr
Orthopaedics & Traumatology, Surgery & Research : OTSR
|November 20, 2012
Summary
Fibular nonunion is a common complication after high tibial osteotomy (HTO), often requiring revision surgery. Specific osteotomy angles and fragment contact can reduce the risk of nonunion in knee osteoarthritis treatment.
Area of Science:
- Orthopedic surgery
- Knee joint biomechanics
- Osteoarthritis treatment
Background:
- Closed-wedge high tibial osteotomy (HTO) is effective for medial knee osteoarthritis.
- Fibular shortening is necessary, with shaft osteotomy posing risks.
- Fibular complications of HTO shaft osteotomy are poorly documented.
Purpose of the Study:
- To determine the incidence and risks of fibular complications after closed-wedge HTO with fibular shaft osteotomy.
- To identify factors influencing fibular nonunion and nerve injury.
Main Methods:
- Prospective study of 108 patients undergoing closed-wedge HTO with fibular shaft osteotomy (1999-2004).
- Clinical and radiological follow-up for 2 years.
- Primary endpoint: fibular nonunion.
Main Results:
- Fibular complications occurred in 16.6% of knees.
- Fibular nonunion was observed in 13.9% (15 knees), with 10.1% (11 knees) requiring revision.
- Nerve injury occurred in 3 knees, with two recovering spontaneously.
Conclusions:
- Fibular nonunion is the most frequent complication of HTO fibular shaft osteotomy, often necessitating revision.
- Preoperative BMI, osteotomy obliquity, and fragment contact influence nonunion risk.
- Obliquity >50° or fragment contact >50% correlated with no nonunion.
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