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First, the new method provides more accurate information about the correction angle since the corrected pitch angle using the new methodology corresponds well with the diving profile.
Thus, the Doppler correction angle should not be used [8].
All osteotomies achieved the planned correction angle (Fig. 8).
The planned correction angle was obtained for all 9 patients with the osteotomies healing primarily.
There was no significant difference in the correction angle between the 16- and 12-mm groups (n=21) (P=.32).
For example, in six of the sixteen osteotomies the correction angle was greater than 8°; the risk of a hinge fracture gets higher when the correction angle increases due to the limited plasticity of the cortical (supracondylar) bone [26].
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Furthermore, all correction angles above 4.5° would lead to crack initiation in the contralateral cortex, even if the more generous strain approach was chosen for design criterion.
In addition, large correction angles (60°) result when a linear transducer is used and this must be especially avoided when comparing middle cerebral artery (MCA)/ICA TAP.
Large correction angles hence always lead at least to micro-cracking in the zone of the tip of the osteotomy cut.
Drilling a hole at the end of the osteotomy reduces the stresses in the lateral cortex and increases the critical opening angle prior to cracking of the opposite cortex in specimen with small correction angles.
Transferred to clinical practice, these data suggest that the hinge pin is an asset, but not the decisive parameter, and it cannot avoid cracking and rupture of the opposite cortex in cases of larger correction angles.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com