{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:39:30Z","timestamp":1790354370553,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T00:00:00Z","timestamp":1671753600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T00:00:00Z","timestamp":1671753600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T00:00:00Z","timestamp":1671753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Closing wedge distal femoral osteotomies (CWDFO) are attractive treatment options for unicompartmental knee osteoarthritis with coronal plane deformity. However, it has been traditionally associated with high rates of hinge fracture that can adversely impact recovery and patient outcomes. Appropriate siting of hinge point can be an effective method of reducing the incidence of hinge fractures. This study aims to illustrate a case series of CWDFO with low rates of hinge fracture utilising our preferred hinge point site.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective study of a cohort of 39 CWDFO was performed between May 2019 and May 2022. Both medial and lateral CWDFO were included. The hinge point in all cases was placed at the level of the inferior margin of the metaphyseal flare, and inferior to the gastrocnemius origin, with a hinge thickness of 10\u00a0mm. Post\u2010operative radiographs were obtained at 2, 4 and 8 weeks after surgery to assess for hinge fracture and union.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010nine cases of CWDFO were performed, consisting of eighteen cases of valgus malalignment that underwent medial CWDFO and twenty\u2010one cases of varus malalignment that underwent lateral CWDFO. At surgery, the mean age was 47.6 (\u00b1\u200913.9) years and mean BMI was 29.4 (\u00b1\u20094.9). There were 23\u00a0men and 16 women. Three cases of hinge fractures occurred intraoperatively, translating into a hinge fracture rate of 7.69%. However, union was achieved in all three cases and all patients in this case series were able to progress to weight bear as tolerated at 2\u00a0months post\u2010osteotomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Distal placement of the hinge at the level of the inferior metaphyseal flare margin with the use of a hinge wire can greatly reduce the rates of hinge fracture in CWDFO.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-022-07286-8","type":"journal-article","created":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T10:03:10Z","timestamp":1671789790000},"page":"3141-3150","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Distalization of hinge site with use of hinge wire reduces hinge fracture rates in closing wedge distal femoral osteotomy"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3737-962X","authenticated-orcid":false,"given":"Shao Jin","family":"Teo","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Singapore General Hospital 20 College Road 169856 Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Don Thong Siang","family":"Koh","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Singapore General Hospital 20 College Road 169856 Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun Wei","family":"Soong","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Singapore General Hospital 20 College Road 169856 Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Yeo","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Singapore General Hospital 20 College Road 169856 Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Wilson","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Trauma and Orthopaedics Basingstoke &amp;, North Hampshire Hospital Basingstoke UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kong Hwee","family":"Lee","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Singapore General Hospital 20 College Road 169856 Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,12,23]]},"reference":[{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.90B5.20386"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2007.01.026"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967116649901"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010019\u201005404\u20107"},{"key":"e_1_2_9_6_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623\u2010199609000\u201000008"},{"key":"e_1_2_9_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010014\u20102953\u20101"},{"key":"e_1_2_9_8_2","doi-asserted-by":"crossref","unstructured":"FujitaK SawaguchiT GoshimaK ShigemotoK IwaiSInfluence of lateral hinge fractures on biplanar medial closing\u2010wedge distal femoral osteotomy for valgus knee: a new classification of lateral hinge fracture.Arch 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September 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 December 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 December 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Adrian Wilson receives royalties from Arthrex and Newclip.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Approval was received from the Institutional Review Board prior to the conduct of this study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Data utilised in the conduct of this study were fully anonymized with all patient identifiers removed by an institution appointed independent third party. As such, a waiver for informed consent was sought and granted by the Institutional Review Board.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}