4. Discussion
stature
The most significant finding of this study was the relatively high risk of D-hole violation during MOWHTO procedures using a CA plate in Asian patients. Distal placement of the plate and a shorter stature were associated with an increased risk of D-hole violation. Moreover, individualized plate designed for Asian patients demonstrated superior fitting with the tibia compared to conventional anatomic plate.Using the D-hole screw for fixation in HTO is important for stability and reducing fragment displacement, in contrast to HTO procedures that do not use D-hole screw fixation [In this study, the difference in D-hole violation rate was larger in the CA plate group (21.4%) compared to the IA plate group (5.5%), and the IA plate exhibited better fitting compared to the CA plate. Previous studies have explored the optimal size and design of HTO plates [This study had several limitations. First, the simulation study used an image-processing technique, which may not fully represent real surgical values. If the D-hole screw is likely to violate the osteotomy plane during actual surgery, alternative methods, such as repositioning the plate or distalizing the osteotomy plane, may be employed to prevent D-hole violations. Second, D-hole violations were defined based on the screw head position in our study. In real surgery, the D-hole screw could penetrate the middle point of the osteotomy plane, reducing the holding force in the lowest portion of the “safe zone” [