During corrective osteotomy, bones are broken and reattached. The main purpose of the surgical procedure is to correct deformities. Risks and complications exist with the general surgical risks and may also be associated with pressure pain from the fixations of the osteotomy.
What is corrective osteotomy?
Corrective osteotomy involves breaking bones and re-fixing them. The surgical procedure is primarily used to correct deformities. Corrective osteotomies are therapeutic operations in which bones are cut in an orthopedic surgical procedure to achieve normal bone or joint anatomy. Such osteotomies can be performed on all bones, but are used primarily on long tubular bones. The pierced portion on these bones is usually the metaphysis, which, unlike the shaft of the bone, is capable of rapid development. The first osteotomy took place before the introduction of anesthetics and was performed in 1826. The surgeon at that time was the American I. R. Barton. However, the procedure was hardly used in the following years. It was not until the introduction of anesthetics and asepsis that osteotomy experienced a revival. In the second half of the 19th century, B. Langenbeck and T. Billroth in particular made their mark on corrective osteotomy. At the same time chisel was introduced in osteotomy. To be distinguished from osteotomy are corticotomy and compactotomy. In these procedures, the cortex of the bone is cut, sparing the medullary vessels and the periosteum of the bone. Corrective osteotomies are now used primarily to rearrange mishealed fractures or to unload portions of a specific joint.
Function, effect, and goals
Corrective osteotomy primarily uses oscillating saws, Gigli saws, sharp chisels, or osteotomy. For osteotomies close to the hip joint, K-wires mark the position of the correction in advance and allow determination of the correction angle. The created gap is spread open during an osteotomy using a distractor. Each osteotomy concludes with osteosynthesis, which reconnects the bones in corrected position and ensures bony healing. Plate osteosynthesis usually takes place as the osteosynthesis. Angle plates are used at some joints. Children are more commonly treated with K-wires. In some areas, retractable screws or Blount clips are also used osteosynthetically. If gaps form during surgery, the gaps are filled with bone chips or artificial bone substitute. Intrinsically, osteotomies can be so stable due to the incision that no final osteosynthesis is required. Bone can be moved and corrected in all directions of the gap depending on the surgical procedures. Among the correction planes is length. Length changes take place, for example, in the course of shortening or lengthening osteotomies. Rotations are also possible through internally and externally rotating osteotomies. The same applies to displacement in the context of translational osteotomies. Tilting into the frontal plane takes place in valgus and varus osteotomies. Tilting in the sagittal plane, on the other hand, accounts for inflecting and extending osteotomies. Osteotomy can also have a corrective effect in several directions at the same time, which is necessary, for example, in cases of hip dysplasia or chronic femoral head dislocation. Four basic types of osteotomy are distinguished. Step and arch osteotomies are extremely rare. Hinged and hinged osteotomies are more commonly used, each of which can be implemented in a transverse or oblique fashion. According to van Heerwaarden and Marti, corrective osteotomies for the treatment of post-traumatic deformities comprise six groups. The first group is the closing-wedge osteotomy with transverse split, in which a shortening half as wide as the base of the bone wedge to be removed is induced. With this form, rotational corrections are easy to implement. Primarily subcapital on the metatarsal, the procedures are used to correct hallux rigidus. The second group of closing-wedge osteotomies with an oblique gap allows correction in two planes and additional shortening or lengthening by moving bone fragments along the osteotomy.The third group of opening-wedge osteotomies with transverse gap allows correction in three planes and is mostly used as intertrochanteric osteotomies for the correction of hip malalignments. The opening-wedge osteotomy with oblique gap also allows correction in three planes. To be distinguished from this is the step or distraction osteotomy, which often takes place to correct femurs in three planes. The arcuate osteotomy allows correction of angulation with intrinsically high stability and is used for elbow malalignment after certain fractures of the humerus.
Risks, side effects, and hazards
As a surgical procedure, corrective osteotomy is associated with common surgical risks. Bleeding, postoperative hemorrhage, infection of the surgical wound, and damage to adjacent tissue structures are among these risks. In addition, osteotomies are usually associated with some period of immobility. Due to immobility, thrombi can develop, especially in the leg veins, with the risk of pulmonary embolism. Anesthesia also carries risks. In more than half of all patients, anesthesia causes nausea or vomiting. In addition, the anesthetic can cause disturbances of the cardiovascular system, which in rare cases can lead to cardiac arrest. Due to artificial respiration during the procedure, some patients later suffer from hoarseness or difficulty swallowing. Specific risks of corrective osteotomies exist when used in the hip region, for example, in different leg lengths. In rare cases, the fixations used to stabilize the bone break, making a second operation necessary. As soon as material wear occurs, the fixations have to be renewed. Some patients also complain of pressure pain due to the fixations. In extreme cases, allergic reactions may develop due to the materials used. In such cases, replacement of the materials is required within another operation.
