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Radiographically, the Kellgren\u2013Lawrence (K\/L) classification, distance between the articular surface and the tip of the fibular head (fibular head position), hinge point (hinge position), type of LHF, and safe zone (within the proximal tibiofibular joint) outlier were evaluated. To determine the cut\u2010off value of the hinge position and fibular head position associated with type III LHF, a receiver operating characteristic (ROC) curve analysis was performed. The odds ratio (OR) was calculated from the obtained cut\u2010off values using logistic regression, which was adjusted by age, gender, body mass index, and opening distance.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 132\u00a0knees in 120 patients, the radiographic severity of knee OA was 19 (14%), 73 (55%), and 40 (30%) of K\/L grades 2, 3, and 4, respectively. LHF was observed in 40\u00a0knees (30%), including types I, II, and III fractures in 21 (16%), 5 (4%), and 14 (11%) knees, respectively. Hinge and fibular head positions were 16 and 10\u00a0mm, respectively, with significant correlation. Safe zone outlier was observed in 38\u00a0knees (29%). The hinge and fibular head positions with type III LHF were significantly higher (more cranial) than those with no fracture or other LHF subtypes. The ROC curve revealed that the cut\u2010off value for the hinge and fibular head positions was 13.3 and 8.6\u00a0mm, respectively. The OR of the hinge and fibular head positions was 22.42 and 13.86, respectively.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>A higher hinge position was a risk factor for type III LHF and was associated with a higher fibular head in patients with knee OA who underwent MOWHTO. The hinge position should be placed at a certain distance from the articular surface to avoid type III LHF, especially in participants with higher fibular head position, even if the hinge position is located in the safe zone.<\/jats:p><\/jats:sec>Level of evidence<\/jats:title>Retrospective cohort study, Level III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-023-07544-3","type":"journal-article","created":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T12:01:56Z","timestamp":1692446516000},"page":"4935-4941","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Higher fibular head is a risk for lateral hinge fracture in medial open wedge high tibial osteotomy"],"prefix":"10.1002","volume":"31","author":[{"given":"Keiichi","family":"Yoshida","sequence":"first","affiliation":[{"name":" Department of Orthopaedics Juntendo University Faculty of Medicine 2\u20101\u20101, Hongo 113\u20108421 Bunkyo\u2010ku Tokyo Japan"},{"name":" Department of Medicine for Orthopedics and Motor Organ Juntendo University Graduate School of Medicine 2\u20101\u20101, Hongo 113\u20108421 Bunkyo\u2010ku Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitsuaki","family":"Kubota","sequence":"additional","affiliation":[{"name":" Department of Orthopaedics Juntendo University Faculty of Medicine 2\u20101\u20101, Hongo 113\u20108421 Bunkyo\u2010ku Tokyo Japan"},{"name":" Department of Medicine for Orthopedics and Motor Organ Juntendo University Graduate School of Medicine 2\u20101\u20101, Hongo 113\u20108421 Bunkyo\u2010ku Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haruka","family":"Kaneko","sequence":"additional","affiliation":[{"name":" Department of Orthopaedics Juntendo University Faculty of Medicine 2\u20101\u20101, Hongo 113\u20108421 Bunkyo\u2010ku Tokyo Japan"},{"name":" Department of Medicine for Orthopedics and Motor Organ Juntendo University 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February 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 August 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 August 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study protocol is complied with the principles outlined in the Declaration of Helsinki and was approved by the Ethical Review Board Committee of the University (approval number: E22-0166).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"As the present study was categorized as a retrospective study, the Ethical Review Board Committee waived the requirement for patients\u2019 informed consent because of the anonymous nature of the data.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}