Percutaneous compression screw fixation for hinge fractures in distal femoral osteotomy does not compromise radiographic or clinical outcomes: A retrospective case‐control study

Abstract Purpose The purpose of this study was to compare radiographic and clinical outcomes between patients undergoing distal femoral osteotomy (DFO) with intraoperative hinge fracture treated with percutaneous compression screw fixation and those without hinge fracture. Methods This retrospective case‐control study included patients undergoing DFO for coronal plane deformity correction between January 2019 and May 2023, with minimum 2‐year follow‐up. Patients sustaining a hinge fracture treated with percutaneous compression screw fixation constituted the case group; patients without hinge fracture served as unmatched controls. Radiographic parameters—including coronal correction (ΔHKA: change in hip–knee–ankle angle), alignment maintenance and radiographic union—and patient‐reported outcome measures (Knee Injury and Osteoarthritis Outcome Score, Lysholm score, Simple Knee Value, UCLA Activity Score, NRS pain score) were assessed pre and postoperatively. Statistical significance was set at p < 0.05. Results Of 130 patients screened, 67 were included: 21 in the hinge fracture group and 46 controls. Mean age was 41.8 ± 13.9 years, 75% were male and mean BMI was 26.8 ± 4.5 kg/m 2 . Baseline demographics were comparable except for osteoarthritis grade, which was more advanced in the hinge fracture group ( p = 0.015). Mean follow‐up was 3.5 ± 1.1 years. Coronal correction did not differ between groups (Δhip–knee–ankle angle: 7.2 ± 3.1° vs. 8.1 ± 3.8°; p = 0.486), and alignment maintenance was comparable. All osteotomies achieved radiographic union. Patient reported outcome measures improved significantly in both groups with no between‐group differences at final follow‐up (Lysholm: 78.3 ± 21.6 vs. 72.7 ± 26.2; p = 0.481). Progressive weight‐bearing initiated at 3 weeks was not associated with loss of correction or delayed union. Conclusion DFO‐associated hinge fractures treated with percutaneous compression screw fixation were not associated with inferior radiographic or clinical outcomes compared with patients without hinge fracture. Progressive weight‐bearing from 3 weeks was safe, supporting this technique as a reliable intraoperative management strategy. Level of Evidence Level III, retrospective comparative cohort.