Editorial Commentary: Lateral Hinge Fracture in High Tibial Osteotomy: Risk or Annex?

The basic aim of the medial opening wedge high tibial osteotomy is to use the elasticity of the lateral cortex as a biomechanical stabilizer, whereas the medial opening gap is maintained by a locking plate. This surgical construct tolerates early weight bearing, free range of knee motion, and sufficient bone healing for an acceptable time. We always perform a biplanar osteotomy, which reduces risk of fracture and improves healing potential owing to more bony contact area. We take some time opening the wedge owing to the elasticity of the lateral cortex. Careless manipulation can harm your hinge! Preoperative planning regarding corrective and postoperative expected joint line angles is key. If the gap is more than 10 mm, we use autologous bone graft or substitute. Partial weight bearing is indicated for 6 weeks to reduce fracture risk. When indicated, we perform double osteotomies, at the distal femur and proximal tibia, to perfectly achieve postoperative joint angles within the intended mechanical axis goal. Fractures of the lateral hinge occur in up to 30% of cases, whereas our nonunion rate is 5.4%.