In a medial opening-wedge high tibial osteotomy (OWHTO), the integrity of the lateral tibial hinge is essential: if the hinge fractures, the osteotomy may lose correction, healing may be delayed, and functional outcomes may suffer. This study addresses whether adding a K-wire intersecting the cutting plane at the theoretical lateral hinge point can reduce hinge fracture incidence.
This retrospective, matched-pair case-control study included 206 patients who underwent OWHTO between January 2014 and December 2017. Among them, 71 had an additional protective K-wire (HK+ group) placed to cross the osteotomy plane at the lateral hinge; 135 did not (HK– group). Through matching, 60 patients in each group were compared (mean follow-up ~2.3 ± 1.0 years). Radiographic assessment (intraoperative fluoroscopy, 6-week CT) evaluated lateral hinge fractures (LHF). Functional outcomes (KOOS), time to bone union, return to work and sport were recorded.
Introducing a protective K-wire across the lateral hinge is a simple, low-cost modification to standard OWHTO surgical technique. It may be especially beneficial in cases with large planned corrections or where bone quality is less ideal. Key technical considerations include accurate placement of the K-wire at the theoretical hinge point and ensuring the wire intersects the osteotomy plane without interfering with fixation. Although retrospective (Level III evidence), the findings support hinge-reinforcement strategies in high-risk settings.
