Aosite, since 1993
High tibial osteotomies (HTO) play a crucial role in the fixation and healing of certain orthopedic procedures. However, a weak hinge poses a significant risk for failure. This study aims to investigate whether the geometry of the cutting edge of the saw blade affects crack initiation or propagation on the hinge, and if certain cutting edge geometries can mitigate this risk.
Materials and Methods:
A finite element model was developed using transversely isotropic elastic bone properties. Three different cutting edge geometries (rectangular, U-shaped, and V-shaped) were compared. A 1.27 mm thick saw cut was made, leaving a 1 cm transverse cortical hinge. Load was applied to open the osteotomy for 1 second. Two simulations were conducted, one without crack initiation and the other with a 15° upward sloping crack, to assess local stress concentrations and calculate the energy release rate of the hinge.
Results:
In the simulation without crack initiation, the rectangular saw blade geometry demonstrated the lowest local stress concentrations. However, in the simulation with crack initiation, the U-shaped geometry exhibited the lowest local stress concentrations and the lowest rate of energy release. This implies that the U-shaped geometry is less likely to initiate and propagate cracks on the lateral cortical hinges.
Discussion/
Although this study utilizes computer modeling and has its limitations, it suggests that the U-shaped cutting edge geometry is the most effective in minimizing the risk of crack initiation or propagation due to its lowest energy release rate. This finding supports our initial hypothesis and reinforces the importance of considering cutting edge geometry in HTO procedures.
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In conclusion, this study highlights the crucial role of cutting edge geometry in the success of high tibial osteotomies. By opting for a U-shaped cutting edge, orthopedic surgeons can minimize the risk of crack initiation or propagation, contributing to better patient outcomes and overall success of the procedure.
The effect of saw blade geometry on crack initiation and propagation on HTO lateral cortical hinges is an important factor to consider when performing orthopedic procedures. Read on to learn more about how different saw blade designs can impact the integrity of the bone during surgery.