Osteotomy




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Original Editor Aarti Sareen

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Introduction

Osteotomy is the surgical cutting of a bone, to allow for re-alignment. It is a surgical procedure which requires careful planning during recovery period and is done under a general anaesthetic. The purpose of osteotomy varies for different joints.

Indications

Generally, people who are under 60 years old, active, and overweight are considered appropriate candidates for osteotomy. It is mainly done to:

• To correct excessive angulation, bowing or rotation of long bones.
  
• To correct mal-alignment of a joint due to mal-union or deformity like coxa vara, genu valgum, and genu varum etc.
  
• To permit elongation or shortening of a bone in cases of Leg Length Discrepancy.
  
• To relieve pain in arthritis, especially of the hip and knee.
  
• Special indications where osteotomy is performed for purposes other than above e.g McMurray's osteotomy.
  

Procedure

After anesthesia is administered, which may be regional, or general, the surgical team sterilizes the part with antibacterial solution.
Surgeons map out the exact size of the bone wedge they will remove, either using an X-ray, CT scan, or 3D computer modeling. The surgeon removes a wedge of bone located near the damaged joint. The procedure is supposed to cause a shift of weight from the area where there is cartilage damage to an area where there is more normal or healthy cartilage.The approach is different for different joints.

Ultimately, the procedure allows weight to be distributed more evenly across the joint cartilage. Osteotomy surgically repositions the joint, realigning the mechanical axis away from the damaged cartilage. Once the wedge of bone is removed, the surgeon brings the bones that remain together and uses pins or staples to secure them. An immobilization cast or internal plates may also be used for stability.

Various types                                        

JOINT	OSTEOTOMIES
Jaw	Dentofacial osteotomy or corrective jaw surgery
Chin	Osteotomy of the Chin
Elbow	French Osteotomy
Spine	Spinal osteotomy
Knee	High tibial osteotomy
Hip	McMurry osteotomy, Pauwel's osteotomy, Salter's osteotomy, Chiari's osteotomy, Pemberton's osteotomy

Jaw Osteotomy

The operation is used to correct jaw problems and dentofacial deformities like maxillary prognathisms, mandibular prognathisms, open bites, difficulty chewing, difficulty swallowing, temporomandibular joint disorder pains, excessive wear of the teeth, and receding chins. Many surgeons prefer this procedure for the correction of a dentofacial deformity due to its effectiveness.

Chin Osteotomy

Chin osteotomy is done either to correct a vertical short chin or to shorten a chin.Chin osteotomies (cutting the bone and moving it) are done through an incision inside the mouth. It is technically more difficult than an implant and has more swelling and recovery than a simple chin implant. Also, there is usually temporary loss of feeling of the lip and chin after that takes several weeks to months for full return of sensation.

Elbow Osteotomy

In the case of elbow fractures (especially supracondylar fractures), post-traumatic deformities can cause changes in the carrying angle of the elbow. The most common late complication of a supracondylar fracture is called a cubitus varus deformity.To correct this varus deformity, a supracondylar osteotomy or french osteotomy is done.

Spinal Osteotomy

Spine osteotomies can be broadly divided into three main types. The type of osteotomy used depends on both the location of the spinal deformity and on the amount of correction that is required. A spinal fusion with instrumentation may also be performed along with spine osteotomy to stabilize the spine and prevent further curvature. The three main types of osteotomy are:

Smith-Petersen Osteotomy (SPO): SPO is recommended in patients in whom a relatively small amount of correction (approximately 10-20° for each level) is required. In this procedure, a section of bone is removed from the back of the spine causing the spine to lean more toward the back. The posterior ligament and facet joints are also removed from this area. Anterior bone graft is not used in this procedure as motion through the anterior portion of the spine or the discs is required for correction. SPO may be performed at one or multiple locations along the spine to restore lordosis.

Pedicle Subtraction Osteotomy (PSO): PSO is recommended generally in patients in whom a correction of approximately 30° is required mainly at the lumbar level. PSO involves all three posterior, middle, and anterior columns of the spine. It involves the removal of posterior element and facet joints similar to a SPO and also removal of a portion of the vertebral body along with the pedicles. PSO allows for more correction of the lordosis than SPO.

Vertebral Column Resection Osteotomy (VCR): VCR involves the complete removal of a single or multiple vertebral bodies. It allows for maximum correction that can be achieved with any spinal osteotomy. As VCR introduces a large defect in the spine, spinal fusion is also performed over these levels for reconstruction. Spinal fusion may involve the use of a structural autograft, structural allograft or metal cage. Initially, VCR was performed through a combined anterior and posterior approach but now it can also be performed through only a posterior approach.

Knee Osteotomy

Knee osteotomy is commonly used to realign your knee structure if you have arthritic damage on only one side of your knee. The goal is to shift your body weight off the damaged area to the other side of your knee, where the cartilage is still healthy. When surgeons remove a wedge of your shinbone from underneath the healthy side of your knee, the shinbone and thighbone can bend away from the damaged cartilage.

Hip Osteotomy

It is mainly of 2 types:

1. INNOMINATE OSTEOTOMIES: Osteotomy of the innominate/iliac bone. The following are some of the innominate osteotomies.
   

Salter's osteotomy: this is an osteotomy of the iliac bone, above the acetabulum. The roof of the acetabulum is rotated with the fulcrum at the pubic symphysis, so that the acetabulum becomes more horizontal, and thus covers the head.

Chiari's pelvic displacement osteotomy: The iliac bone is divided almost tranversely immediately above the acetabulum, and the lower fragment is displaced medially. The margin of the upper fragment provides additional depth to the acetabulum.

Pemberton's pericapsular osteotomy: A curved osteotomy is made and the roof of the acetabulum is deflected downwards over the femoral head, with the fulcrum at the triradiate cartilage of the acetabulum.

2. FEMORAL OSTEOTOMIES: Osteotomy of the femur bone.

References

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