ArticleBMC musculoskeletal disorders2021
Monocortical fixation for locking plate distal screws does not impair mechanical properties in open-wedge high tibial osteotomy.
Article in BMC musculoskeletal disorders, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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5 citing papers in PubMed, 7 citations in OpenAlex.
- Postoperative alignment and patients reported outcome measures improvement after high tibial osteotomy: a significant interaction with osteoarthritis severity.Archives of orthopaedic and trauma surgery · 2026Article
- Optimizing clavicle hook plate fixation through biomechanical analysis of pre-bent plate condition and screw configurations.Frontiers in medicine · 2026Article
- Do monocortical distal locking screws impair mechanical properties in opening wedge high tibial osteotomy with bone graft?-a sawbone biomechanical study.Annals of translational medicine · 2025Article
- Impact of support instruments in medial closed-wedge distal femoral osteotomy: a finite element analysis.Archives of orthopaedic and trauma surgery · 2024Article
- Tibial shaft fracture after medial open-wedge distal tibial tuberosity osteotomy: A case report.Clinical case reports · 2022Article
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe neurovascular bundle containing the deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy (OWHTO), particularly due to drilling for bicortical fixation at distal screw holes. Therefore, monocortical fixation is recommended for distal fixation of a long locking plate as long as good stability is ensured. The purpose of this study was to analyse the biomechanical properties of monocortical fixation of distal locking screws for OWHTO.
methodsThree-dimensional models of bone and fixation materials simulating OWHTO were created using computed tomographic data of patients and material data of a T-shaped long locking plate and screws. Three of the four distal screws of the locking plate were chosen for a bicortical fixation or monocortical fixation procedure. In addition, loss of correction was assessed by measuring the medial proximal tibial angle (MPTA) in patients who underwent OWHTO with two bicortical and two monocortical distal fixation screws at 1 month and 1 year after surgery.
resultsNo significant differences in stress were observed in either the normal or osteoporotic bone model between the monocortical and bicortical fixation models, including in the area of the lateral hinge at the osteotomy site. Furthermore, there were no significant differences in MPTA between the early post-operative period and 1-year follow-up.
conclusionsThe monocortical fixation method for three distal screws of the locking plate did not worsen the mechanical properties of fixation for OWHTO using a long locking plate with four proximal and four distal screws. In actual surgery, the number of distal bicortical screws should be reduced based on the patient's condition, taking into account the risk of lateral hinge fracture and unexpected surgical complications. Using at least two bicortical screws would be practical considering the various factors related to reduced fixing ability.
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