Biomechanical investigation of the type and configuration of screws used in high tibial osteotomy with titanium locking plate and screw fixation

Background: To maintain the corrected alignment after high tibial osteotomy (HTO), fixation with titanium locking plate and screws is widely used in current practice; however, screw breakage is a common complication. Thus, this study was to investigate the mechanical stability of HTO with locking plate and various screw fixations, including the length as well as the type. Methods: A finite element (FE) model involving a distal femur, meniscus, and a proximal tibia with HTO fixed with a titanium locking plate and screws was created. The angle of the medial open wedge was 12 degrees, and bone graft was not used. Two types of screws, namely conventional locking and far-cortical locking screws, with various lengths and configurations were used. At the proximal tibia, conventional locking screws with different lengths, 30 and 55 mm, were used; at the tibia shaft, different screw fixations including one-cortical, two-cortical, and far-cortical locking screws were used. Results: The use of far-cortical locking screw generated the highest equivalent stress on the screws, which was four times (from 1373 to 541 MPa) higher than that of the one-cortical screw. Also, it led to the maximum deformation of the tibia and a greater gap deformation at the osteotomy site, which was twice (from 0.222 to 0.442 mm) larger than that of the one-cortical screw. The effect of different locking screw length on tibia deformation and implant stress was minor. Conclusion: Thus, far-cortical locking screws and plates increase interfragmentary movement but the screw stress is relatively high. Increasing the protection time (partial weight duration) is suggested to decrease the risk of screw breakage in HTO through fixation with titanium far-cortical locking screws and plates.