Corrective osteotomy
Definition
A repositioning osteotomy is understood to be the removal of one or more bone connections from each other, the correction of the deviating axes and the rejoining of the bone connections in the presence of malpositioned joints. Rearrangement osteotomies are always performed when considerable axial displacement and malalignment has occurred in various joints of the skeleton and an orthopedic-technical correction in the form of splints or insoles has been unsuccessful. The indication for a sometimes costly operation is only ever given if there are accompanying complaints of the patient, such as far-reaching malpositions or restrictions in gait, sitting and lying.
Furthermore, an indication for such an operation can be too much suffering of the patient. Since bones are rigid in a healthy state, malalignments are only caused by irregular wear and tear in the adjacent joint. Bow legs, for example, are only caused by the inner side of the knee joint being too far apart and an increased pressure on the outer side.
The axis of the leg thus runs too far outwards. Adjustment osteotomies are only performed if there are significant changes in the joints and accompanying malpositions. In most cases, these malpositions have developed over years and have increasingly led to the affected person being restricted in their everyday life and movements. Most frequently, repositioning osteotomies are performed on the hip, knee and toes.
Diagnosis
The orthopedist determines the indication for the procedure. By questioning him, he first determines how long a given malposition has existed and which non-surgical measures have already been taken (wearing insoles, etc.). This is followed by a physical examination with measuring the axes, determining the angle and measuring the leg (toe) lengths.
In order to get an objective impression of the bone condition, x-rays of the corresponding joint and bones are always taken, usually in two planes. With the help of these x-rays, in which angles and axes are also drawn in, the orthopedist can plan the operation in advance. After each indication, the patient is also given detailed information and informed about the side effects and risks of a repositioning osteotomy.
As a rule, corrective osteotomies are performed in one operation. In the case of complex malpositions, however, it may be necessary to attach an external fixator after initial correction of the malposition. These are metal rods that are attached outside the body and are connected to the bone or joint by cross-bracing through small holes. After a few weeks, a second procedure is performed, in which the frame and the cross braces are removed again.
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