Osteotomy is a surgical procedure that is used to correct bone deformities. Often, these are misalignments of the leg, foot or jaw bones.
What is osteotomy?
If patients suffer from hallux valgus, or a crooked big toe, a pivot osteotomy of the metatarsal bone is usually performed. Ideally, the big toe is straightened after the procedure. The basic principle of osteotomy is the controlled cutting of one or more bones. This is followed by surgical straightening by means of osteosynthesis. This involves reconnecting the previously severed bones with the goal of having them grow back together in the corrected shape. Osteotomy is often performed to correct bow legs, knock knees and hip deformities. In this case, it is called a realignment or corrective osteotomy. In dental surgery, osteotomies are usually used to rearrange the jaw bones. These jaw osteotomies are used in cases of severe jaw deformities. Osteotomies may also be necessary when removing wisdom teeth, as wisdom teeth are often stuck in the bone. In the broadest sense, this is also referred to as an osteotomy of the jaw.
Function, effect and goals
One of the most commonly used osteotomies is the derotation variation osteotomy, which is used primarily for hip deformities. In this procedure, the femur is cut at a specific location, a small wedge of bone is removed, and the two resulting pieces of bone are screwed back together with a metal splint. If such a hip deformity is not corrected with an osteotomy, there is a risk of arthrosis due to the incorrect loading of the hip joint. If the lower leg deviates too far inward, this is called a varus position of the lower leg. This malposition causes a deformity of the knee joint, so that the malposition can also lead to early arthrosis. To prevent osteoarthritis, the tibia bone is cut just below the knee joint. Again, a piece of the bone is removed to correct the malalignment of the lower leg. Plate osteosynthesis or staples are used to rejoin the two pieces of bone in the tibia. If the procedure is done early, the use of an artificial knee joint can be delayed by several years. This procedure is also called a tibial plateau osteotomy and is often used to correct bow legs. Another osteotomy procedure, Maquet-Bandi surgery, is also used for knee joint problems. Here, the attachment point of the hamstring is moved to the side in front and fixed there with screws. If patients suffer from hallux valgus, i.e. a crooked big toe, a pivot osteotomy of the metatarsal bone is usually performed. In this procedure, the first metatarsal bone is surgically cut, the malposition is corrected and the bone is then fixed again by means of a perforated plate so that, ideally, the big toe is straightened again after the procedure. A variation of the pivot osteotomy is the scarf osteotomy which is also performed for hallux valgus correction. The usual procedure to correct unequal leg lengths is the lengthening osteotomy. Unequal leg lengths can be congenital or caused by accidents. While differences of up to two centimeters in leg length can still be compensated with appropriate orthopedic footwear, a difference of four centimeters or more often requires surgical lengthening of the shorter leg. The most common procedure here is a so-called callus distraction. In this procedure, the surgeon cuts the bone to be lengthened transversely and inserts a distractor, i.e. a spreader, into the resulting gap between the two parts of the bone. For this purpose, small pins are fixed in the bone and connected to a holding system from the outside. With the aid of this distractor, the bone fragments can be slowly pulled apart. Once the desired lengthening has been achieved, a plate osteosynthesis is usually performed, i.e. the bone fragments are connected with a steel plate. Femoral neck osteotomy is part of the surgical procedure for inserting a hip prosthesis. Here, the entire femoral head is removed. This may also be indicated for infections of the hip joint. Rarely, osteotomies are performed on the spine.In this procedure, also known as laminectomy, the vertebral arch of one or more vertebral bodies is removed along with the spinous process. This makes room for operations on the spinal cord or the intervertebral discs. Also, when tumors in the spinal canal cause a lot of pressure on the spinal cord, a laminectomy can be helpful in relieving pressure on the corresponding region.
Risks, side effects, and dangers
Of course, because osteotomy is a surgical procedure, general surgical risks apply here. These include bleeding and rebleeding that is difficult to control, infection of the surgical wound (possibly even with multidrug-resistant germs), and damage to adjacent tissue structures. Osteotomies in the leg area in particular lead to immobility for a period of time. As a result, clots (thrombi) can form in the deep veins of the legs. This so-called thrombosis carries the risk of pulmonary embolism. In this case, the clot travels through the blood vessels to the lungs, where it leads to vascular occlusion. In the case of very small vessels, the pulmonary embolism may be asymptomatic; in the case of the occlusion of a large vessel, there is an acute danger to life. Another typical surgical risk is anesthesia. About one third of all patients react to anesthesia with nausea or vomiting. In addition, disturbances of the cardiovascular system and, in the worst case, cardiac arrest can occur. Artificial respiration during surgery can also cause difficulty swallowing or hoarseness. In addition to these general risks, the osteotomy procedure also carries other specific risks and complications. For example, osteotomies in the hip area can result in different leg lengths. However, these can usually be compensated for with orthopedic inserts. Rarely, the fixations used to stabilize the bones after they are cut can break. In addition, the materials used in fixation are not protected from wear and may need to be replaced in follow-up surgeries. In rare cases, the fixations used may also cause pressure pain.
