# Clinical Outcome of Combined Types 1, 2, and 3 Lateral Hinge Fractures After Open-Wedge High Tibial Osteotomy: A Case Report

## TL;DR

A rare case of combined lateral hinge fractures after knee surgery was successfully treated with limited weight-bearing and ultrasound, leading to full recovery.

## Contribution

This case report presents a rare combination of lateral hinge fracture types and demonstrates an effective treatment approach using LIPUS.

## Key findings

- Combined types 1, 2, and 3 lateral hinge fractures occurred after OWHTO in a patient with bone atrophy.
- Treatment with weight-bearing restriction and LIPUS resulted in successful bone healing and functional recovery.
- Factors like bone atrophy and surgical technique contributed to the fracture complexity.

## Abstract

Lateral hinge fractures (LHFs) after open-wedge high tibial osteotomy (OWHTO) pose the risk of delayed bone union and loss of correction, and their management remains a challenge. The following case report describes a rare case of combined type 1, 2, and 3 LHFs following OWHTO. The patient was a 48-year-old female with a history of desmoid tumor resection and radiotherapy on the ipsilateral posterior aspect of the thigh, which was distal to the popliteal area of the knee. Bone atrophy was observed in the proximal tibia. OWHTO was performed for medial knee osteoarthritis (Kellgren-Lawrence grade 3) with a correction angle of 13°. Two months after surgery, types 1, 2, and 3 LHFs were identified. Treatment included weight-bearing restriction and low-intensity pulsed ultrasound (LIPUS), which resulted in successful bone healing. During the 16-month follow-up, the patient was pain-free and could walk smoothly. This case was complicated by types 1, 2, and 3 LHFs after OWHTO because of factors such as large preoperative hip-knee-ankle angle, proximal tibia bone atrophy, insufficient screw length, and the distance between the plate and bone. The combination of weight-bearing restriction and LIPUS effectively managed multiple LHFs after OWHTO, preventing significant correction loss and nonunion by promoting bone healing.