Biomechanical insights to mitigate lateral hinge fracture risk in opening-wedge high tibial osteotomy

Lateral hinge fractures (LHFs) are serious complications of high tibial osteotomy (HTO). We aimed to establish the relationship between osteotomy parameters and LHF risk factors using finite element simulation. The parameters analyzed included cutting position, hinge position, and correction angle. Optimizing the hinge position in HTO reduced stress and strain concentrations. An osteotomy with a 40 mm cutting position and an AL hinge effectively minimized force moments and stress while ensuring that strain remained below the cortical bone's yield limit. These findings highlight the importance of optimizing osteotomy parameters to reduce LHF risk and improve surgical outcomes in HTO.