{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T04:18:43Z","timestamp":1769228323666,"version":"3.49.0"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","issue":"09","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The effect of osteotomy type on the initial stiffness of the bone-implant construct in lateral opening-wedge distal femoral osteotomy (LOWDFO) using a uniplanar compared with a biplanar technique has been investigated. However, no study has explored the biomechanical risk factors for medial hinge fracture. This study aimed to compare the biomechanical strength of uniplanar versus biplanar LOWDFO regarding the risk for medial hinge fracture during gap opening. Twelve composite femora were divided into two groups (six in each group) based on the distal femoral osteotomy technique: uniplanar versus biplanar LOWDFO. All LOWDFO models were subjected to incremental static loading. The gap distance was expanded by 1\u2009mm, and displacement values were recorded as anterior and posterior gap distances (mm). The average force values of all samples at certain gap distances were recorded, and the head distance was measured. The uniplanar group had higher load values than the biplanar group at all anterior gap distances. These differences were only significant at 2- and 3-mm gap distances (p\u2009=\u20090.025 and 0.037). At all posterior gap distances, the uniplanar group had higher load values than the biplanar group, but these differences only reached statistical significance at 2\u2009mm (p\u2009=\u20090.037). Both groups had similar anterior, posterior, and average gap distances (p\u2009=\u20090.75, 0.522, 0.873). The uniplanar group had a higher head insertion distance (15.3\u2009\u00b1\u20095.7) than the biplanar group (14.7\u2009\u00b1\u20092.9), but it was not significant (p\u2009=\u20090.87). The uniplanar group had a lower average load before medial hinge fracture (46.41\u2009\u00b1\u200913.91\u2009N) than the biplanar group (54.92\u2009\u00b1\u200931.94, p\u2009=\u20090.81). The biplanar group had an average maximum load value of 64.18\u2009\u00b1\u200925.6\u2009N, while the uniplanar group had 57.90\u2009\u00b1\u200912.21\u2009N (p\u2009=\u20090.81). This study revealed that the biplanar osteotomy technique allows a wider opening wedge gap with less risk of a medial hinge fracture than uniplanar LOWDFO.<\/jats:p><jats:p>Level of evidence was level 3, case\u2013control series.<\/jats:p>","DOI":"10.1055\/a-2232-4971","type":"journal-article","created":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T23:54:23Z","timestamp":1703030063000},"page":"623-630","source":"Crossref","is-referenced-by-count":2,"title":["Biomechanical Comparison of Uniplanar versus Biplanar Lateral Opening-wedge Distal Femoral Osteotomy Techniques in Terms of Risk for Medial Hinge Fracture"],"prefix":"10.1055","volume":"37","author":[{"given":"Cem","family":"Y\u0131ld\u0131r\u0131m","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehmet","family":"Demirel","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, \u0130stanbul University, Istanbul School of Medicine, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehmet","family":"Ekinci","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Traumatology, Haseki Training and Research Hospital, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simge","family":"\u00d6zt\u00fcrk","sequence":"additional","affiliation":[{"name":"Mechanical Engineering Faculty, Istanbul Technical University, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S\u00fcreyya Erg\u00fcn","family":"Bozda\u011f","sequence":"additional","affiliation":[{"name":"Mechanical Engineering Faculty, Istanbul Technical University, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,2,27]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1007\/s12178-014-9233-z","article-title":"Distal femoral osteotomy","volume":"7","author":"F Rosso","year":"2014","journal-title":"Curr Rev Musculoskelet Med"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.csm.2019.02.004","article-title":"Lateral opening wedge distal femoral osteotomy for lateral compartment arthrosis\/overload","volume":"38","author":"C Pilone","year":"2019","journal-title":"Clin Sports Med"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1177\/0363546513516577","article-title":"Medial opening wedge high tibial osteotomy for medial compartment overload\/arthritis in the varus knee: prognostic factors","volume":"42","author":"D E Bonasia","year":"2014","journal-title":"Am J Sports Med"},{"issue":"10","key":"ref4","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.1016\/j.arthro.2016.04.010","article-title":"Distal femoral osteotomy for the valgus knee: medial closing wedge versus lateral opening wedge: a systematic review","volume":"32","author":"J D Wylie","year":"2016","journal-title":"Arthroscopy"},{"issue":"07","key":"ref5","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.1007\/s00167-018-5332-5","article-title":"Opening-wedge osteotomies of the distal femur: minor advantages for a biplanar compared to a uniplanar technique","volume":"27","author":"M Pietsch","year":"2019","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"06","key":"ref6","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.1007\/s11999-014-4106-8","article-title":"Lateral opening-wedge distal femoral osteotomy: pain relief, functional improvement, and survivorship at 5 years","volume":"473","author":"J I Cameron","year":"2015","journal-title":"Clin Orthop Relat Res"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1007\/s00167-012-2127-y","article-title":"Wedge volume and osteotomy surface depend on surgical technique for distal femoral osteotomy","volume":"21","author":"R van Heerwaarden","year":"2013","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"09","key":"ref8","doi-asserted-by":"crossref","first-page":"2914","DOI":"10.1007\/s00167-016-4049-6","article-title":"Comparison of monoplanar versus biplanar medial opening-wedge high tibial osteotomy techniques for preventing lateral cortex fracture","volume":"25","author":"F T\u00fcrkmen","year":"2017","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"20","key":"ref9","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1016\/S0142-9612(97)00073-2","article-title":"Elastic properties of human cortical and trabecular lamellar bone measured by nanoindentation","volume":"18","author":"J-Y Rho","year":"1997","journal-title":"Biomaterials"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1007\/s00167-005-0690-1","article-title":"Primary stability of four different implants for opening wedge high tibial osteotomy","volume":"14","author":"J D Agneskirchner","year":"2006","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s00264-017-3504-4","article-title":"Nonunion and delayed union in lateral open wedge distal femoral osteotomies-a legitimate concern?","volume":"42","author":"F Liska","year":"2018","journal-title":"Int Orthop"},{"issue":"10","key":"ref12","doi-asserted-by":"crossref","first-page":"3382","DOI":"10.1007\/s00167-020-06244-6","article-title":"A hinge position distal to the adductor tubercle minimizes the risk of hinge fractures in lateral open wedge distal femoral osteotomy","volume":"29","author":"P W Winkler","year":"2021","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"06","key":"ref13","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1007\/s00402-010-1193-1","article-title":"Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique","volume":"131","author":"M Jacobi","year":"2011","journal-title":"Arch Orthop Trauma Surg"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.knee.2013.08.014","article-title":"Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee","volume":"21","author":"A Saithna","year":"2014","journal-title":"Knee"},{"issue":"05","key":"ref15","doi-asserted-by":"crossref","first-page":"1702","DOI":"10.1007\/s00167-016-3988-2","article-title":"Good functional results of distal femoral opening-wedge osteotomy of knees with lateral osteoarthritis","volume":"24","author":"A Ekeland","year":"2016","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1007\/s00167-021-06466-2","article-title":"Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy","volume":"30","author":"M C Rupp","year":"2022","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"288","key":"ref17","first-page":"263","article-title":"Distal femoral varus osteotomy for painful genu valgum. A five-to-11-year follow-up study","author":"B C Edgerton","year":"1993","journal-title":"Clin Orthop Relat Res"},{"issue":"09","key":"ref18","doi-asserted-by":"crossref","first-page":"e1323","DOI":"10.1016\/j.eats.2020.05.013","article-title":"Technique for Biplanar lateral opening wedge distal femoral osteotomy in the valgus knee","volume":"9","author":"R A Duerr","year":"2020","journal-title":"Arthrosc Tech"},{"issue":"04","key":"ref19","doi-asserted-by":"crossref","first-page":"e799","DOI":"10.1016\/j.eats.2016.03.009","article-title":"Varus-producing lateral distal femoral opening-wedge osteotomy","volume":"5","author":"J J Mitchell","year":"2016","journal-title":"Arthrosc Tech"},{"issue":"04","key":"ref20","doi-asserted-by":"crossref","first-page":"e725","DOI":"10.1016\/j.eats.2016.02.037","article-title":"Distal femoral osteotomy: lateral opening wedge technique","volume":"5","author":"M P O'Malley","year":"2016","journal-title":"Arthrosc Tech"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.arthro.2011.06.034","article-title":"Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture","volume":"28","author":"R Takeuchi","year":"2012","journal-title":"Arthroscopy"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2232-4971.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T14:01:26Z","timestamp":1730815286000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2232-4971"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,19]]},"references-count":21,"journal-issue":{"issue":"09","published-online":{"date-parts":[[2024,6,27]]},"published-print":{"date-parts":[[2024,7]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2232-4971","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,12,19]]},"published":{"date-parts":[[2023,12,19]]}}}