Repositioned Kirschner Wires as a Temporary Metaphyseal Block to Prevent Articular Extension During Opening-Wedge...

Lateral hinge fracture is a frequent complication of medial opening-wedge high tibial osteotomy. Previous strategies-such as inserting an additional third Kirschner wire (K-wire) from the lateral tibial cortex-reinforce the lateral cortex but do not address the potential fracture line that propagates proximally toward the tibial plateau and joint surface. We describe a simple maneuver that reuses the 2 K-wires routinely employed to guide the osteotomy plane. Once the osteotomy cut is complete, the wires are withdrawn and reinserted horizontally into the proximal metaphyseal tibia, just above the osteotomy gap. Acting as a temporary metaphyseal block, the wires stabilize the epiphyseal-metaphyseal unit and limit upward fracture propagation into the joint during gradual gap opening. This simple technique is cost-neutral, reproducible, and complements existing hinge-protection methods by specifically protecting the articular extension pathway.