Smoking and lateral hinge fracture are associated with delayed union at 6 months in open wedge distal tibial tuberosity osteotomy.
retrospective_cohort · Level III
Where this comes from
- Record sourced from PubMed, PMID 42415945.
- Also identified by DOI 10.1002/jeo2.70829 and PMC identifier 13340138.
- Licence recorded as CC BY.
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Abstract
This study aimed to identify risk factors for delayed union 6 months after open wedge distal tibial tuberosity osteotomy (owDTO) using computed tomography (CT) and to evaluate the association between distal flange and posterior cortex union. This retrospective study was conducted on all patients who underwent owDTO. The exclusion criteria were failure to undergo a 6-month postoperative follow-up, absence of CT evaluation, simultaneous anterior cruciate ligament reconstruction, double-level osteotomy and cases requiring multiple surgical debridements for deep infection. Bone union rates at the flange and posterior cortex were evaluated using CT images obtained 6 months postoperatively. Bone union was determined using zone classification from a previous report. Various factors influencing bone union were examined. Statistical significance was set at <i>p</i> < 0.05. Of the 122 knees reviewed, a total of 79 knees from 77 patients (43 males and 34 females; age, 55 ± 10 years) were analysed after the exclusion of 43 knees. Twenty-two patients were current smokers. The body mass index was 25.1 ± 3.8 kg/m<sup>2</sup>. Bone union at 6 months was observed in the posterior cortex, distal flange and proximal flange in 55 (69.6%), 67 (84.8%) and 76 (96.2%) knees, respectively. Lateral hinge fracture (LHF) occurred in 20 knees. The posterior cortex union rate was significantly higher in the distal flange union group than in the delayed union group (77.6% vs. 25.0%, <i>p</i> < 0.01). LHF was significantly associated with posterior cortex delayed union (<i>p</i> = 0.03). Smoking was significantly associated with distal flange delayed union (<i>p</i> = 0.02). Smoking and LHF were associated with delayed union at 6 months in owDTO. Distal flange union was significantly associated with posterior cortex union. These findings may assist surgeons in identifying patients at risk for delayed union after owDTO and may contribute to improved postoperative management. Level IV, retrospective study.