Quantitative analysis of protective Kirschner wire diameters in lateral opening wedge distal femoral osteotomy: A finite element study

Abstract

Objectives: This study aims to investigate quantitatively the protective effect of a 1.6-mm or a 2.5-mm Kirschner wire (K-wire) on the medial hinge at different gap distances through finite element analysis (FEA) and to establish whether using a 2.5-mm K-wire can offer benefits compared to a 1.6-mm in preventing medial hinge fractures.

Materials and methods: Between June 2024 and July 2024, three different models simulating a lateral opening wedge (LOW) osteotomy of the distal femur were created from a femoral computed tomography (CT) scan of a 36-year-old male patient: no K-wire (Model I), 1.6-mm K-wire (Model II), and 2.5-mm K-wire (Model III). Finite element analysis was performed to simulate 7- to 13-mm gaps at the osteotomy site. Loads, principal stress, strain, and equivalent stress were analyzed around the medial hinge.

Results: Model I required 123.0±5.2 N, Model II required 181.7±12.2 N, and Model III required 228.7±13.6 N (p<0.001). Cracked shell elements were the lowest in Model II and the highest in Model I. While the average equivalent/yield stress ratio was not significantly lower in Model II compared to Model III (87.0±10.9% vs. 92.7±12.1%), the maximum equivalent/yield stress ratio values in Model II were significantly lower than both Model I and Model III (1206.2±138.3% vs. 1836.2±165.4% and 1689.1±404.0%, respectively), suggesting a superior dispersion of forces.

Conclusion: Using a 1.6-mm K-wire during LOW osteotomy of the distal femur provides a balance between structural reinforcement and stress distribution, significantly improving stability and reducing the risk of medial hinge fractures compared to a 2.5-mm K-wire or no K-wire. The 1.6-mm K-wire optimizes stress dispersion, making it the preferred choice for surgical planning in lateral opening wedge distal femoral osteotomy.

Citation: Baris A, Özmen E, Circi E, Yuksel S, Beytemür O. Quantitative analysis of protective Kirschner wire diameters in lateral opening wedge distal femoral osteotomy: A finite element study. Jt Dis Relat Surg 2025;36(1):97-106. doi: 10.52312/ jdrs.2025.1806.

Idea/concept, writing the article: E.Ö., A.B.; Design: E.Ö., A.B., O.B.; Control/supervision: S.Y.; Data collection and/or processing: E.Ö., A.B., S.Y; Analysis and/ or interpretation, references and fundings, materials: E.Ö.; Literature review: E.C., E.Ö; Critical review: E.C., S.Y., O.B.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

The authors received no financial support for the research and/or authorship of this article.

During the preparation of this study the authors used ChatGPT (OpenAI, San Francisco, CA, USA) in for grammar and syntax editing. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication. The final manuscript was reviewed by a professional translator.

The data that support the findings of this study are available from the corresponding author upon reasonable request.