Hinge screw or no hinge stabilization provides decreased stability compared to hinge plate in a biomechanical evaluation of distal femoral derotational osteotomies

Purpose Derotational distal femoral osteotomy (DFO) is the causal treatment for patients with femoral torsional deformity. The fixation is achieved by a unilateral angle‐stable plate. Delayed‐ or non‐unions are one of the main risks of the procedure. An additional contralateral fixation may benefit the outcome. Therefore, we hypothesize that primary stability in DFO can be improved by an additional fixation with a hinge screw or an internal plate. Methods Derotational DFO was performed in 15 knees and fixed either with an angle‐stable plate only (group ‘None’), with an additional lateral screw (group ‘Screw’) or with an additional lateral plate (group ‘Plate’). Biomechanical evaluation was carried out under axial loading of 150 N (partial weight bearing) and 800 N (full weight bearing), followed by internal and external rotation. After linear axial loading in step 1, a cyclic torsional load of 5 Nm was applied under constant axial load in step 2. In step 3, the specimens were unloaded. Micromovements between the distal and proximal parts of the osteotomy were recorded at each step for all specimens. Results In step 1, the extent of micromovements was highest in group ‘None’ and lowest in group ‘Plate’ without being significantly different. In step 2, group ‘Plate’ showed significantly higher stability, reflected by less rotation and lower micromovements. Increasing the axial load from 150 to 800 N at step 2 resulted in increased stability in all groups but only reached significance in group ‘None’. Conclusion An additional contralateral plate significantly increased stability in derotational DFO compared to the unilateral angle‐stable plate only. Contrary, a contralateral hinge screw did not provide improved stability. Study Design Experimental study. Level of Evidence IV.