{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T10:32:07Z","timestamp":1788258727741,"version":"build-2803163510"},"reference-count":54,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,2,27]],"date-time":"2021-02-27T00:00:00Z","timestamp":1614384000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,2,27]],"date-time":"2021-02-27T00:00:00Z","timestamp":1614384000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,2,27]],"date-time":"2021-02-27T00:00:00Z","timestamp":1614384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Projekt DEAL"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To evaluate the incidence, morphology, and associated complications of medial cortical hinge fractures after lateral closing wedge distal femoral osteotomy (LCW\u2010DFO) for varus malalignment and to identify constitutional and technical factors predisposing for hinge fracture and consecutive complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Seventy\u2010nine consecutive patients with a mean age of 47\u2009\u00b1\u200912 years who underwent LCW\u2010DFO for symptomatic varus malalignment at the authors\u2019 institution between 01\/2007 and 03\/2018 with a minimum of 2\u2010year postoperative time interval were enrolled in this retrospective observational study. Demographic and surgical data were collected. Measurements evaluating the osteotomy cut (length, wedge height, hinge angle) and the location of the hinge (craniocaudal and mediolateral orientation, relation to the adductor tubercle) were conducted on postoperative anterior\u2013posterior knee radiographs and the incidence and morphology of medial cortical hinge fractures was assessed. A risk factor analysis of constitutional and technical factors predisposing for the incidence of a medial cortical hinge fracture and consecutive complications was conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The incidence of medial cortical hinge fractures was 48%. The most frequent morphological type was an extension fracture type (68%), followed by a proximal (21%) and distal fracture type (11%). An increased length of the osteotomy in mm (53.1\u2009\u00b1\u200910.9 vs. 57.7\u2009\u00b1\u20099.6; <jats:italic>p<\/jats:italic>\u2009=\u20090.049), an increased height of the excised wedge in mm (6.5\u2009\u00b1\u20091.9 vs. 7.9\u2009\u00b1\u20093; <jats:italic>p<\/jats:italic>\u2009=\u20090.040) as well as a hinge location in the medial sector of an established sector grid (<jats:italic>p<\/jats:italic>\u2009=\u20090.049) were shown to significantly predispose for the incidence of a medial cortical hinge fracture. The incidence of malunion after hinge fracture (14%) was significantly increased after mediolateral dislocation of the medial cortical bone\u2009&gt;\u20092\u00a0mm (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05).\n<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Medial cortical hinge fractures after LCW\u2010DFO are a common finding. An increased risk of sustaining a hinge fracture has to be expected with increasing osteotomy wedge height and a hinge position close to the medial cortex. Furthermore, dislocation of a medial hinge fracture\u2009&gt;\u20092\u00a0mm was associated with malunion and should, therefore, be avoided.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Prognostic study; Level IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-021-06466-2","type":"journal-article","created":{"date-parts":[[2021,2,27]],"date-time":"2021-02-27T02:02:36Z","timestamp":1614391356000},"page":"982-992","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy"],"prefix":"10.1002","volume":"30","author":[{"given":"Marco\u2010Christopher","family":"Rupp","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Sports Medicine, Klinikum Rechts der Isar Technical University of Munich Ismaninger Str. 22 81675 Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp W.","family":"Winkler","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Sports Medicine, Klinikum Rechts der Isar Technical University of Munich Ismaninger Str. 22 81675 Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia M.","family":"Lutz","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Sports Medicine, Klinikum Rechts der Isar Technical University of Munich Ismaninger Str. 22 81675 Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Irger","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Sports Medicine, Klinikum Rechts der Isar Technical University of Munich Ismaninger Str. 22 81675 Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Forkel","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Sports Medicine, Klinikum Rechts der Isar Technical University of Munich Ismaninger Str. 22 81675 Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5085-6446","authenticated-orcid":false,"given":"Andreas B.","family":"Imhoff","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Sports Medicine, Klinikum Rechts der Isar Technical University of Munich Ismaninger Str. 22 81675 Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias J.","family":"Feucht","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Sports Medicine, Klinikum Rechts der Isar Technical University of Munich Ismaninger Str. 22 81675 Munich Germany"},{"name":"<!--<label>2<\/label>--> Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine Albert\u2010Ludwigs\u2010University of Freiburg Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,2,27]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2020.04.019"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200208000-00014"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-014-2998-1"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-014-4106-8"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2017.10.025"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-012-2156-6"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-015-3730-5"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199303000-00033"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-016-3988-2"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.3758\/BF03193146"},{"key":"e_1_2_10_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.37726"},{"key":"e_1_2_10_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00064-017-0503-y"},{"key":"e_1_2_10_14_2","doi-asserted-by":"crossref","unstructured":"FeuchtMJ WinklerPW MehlJ BodeG ForkelP ImhoffABet al. 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Imhoff is a consultant for Arthrosurface and Medi Bayreuth and receives royalties from Arthrex and Arthrosurface.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethical approval was obtained from the Ethics Committee of the Technical University Munich (Nr.: 6\/20 S). All the procedures performed were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}