Treatments & Therapies

Corrective osteotomy – treatment, effects & risks

Corrective osteotomy

During the corrective osteotomy , bones are broken and refixed. The surgical procedure is primarily used to correct misalignments. Risks and complications exist with the general surgical risks and can also be associated with pressure pain from the fixations of the osteotomy .

What is the corrective osteotomy?

Corrective osteotomy are therapeutic operations in which bones are severed in an orthopedic surgical procedure in order to achieve a normal bone or joint anatomy. Such osteotomies can be performed on all bones, but are mainly used on long tubular bones.

The perforated portion of these bones is usually the metaphysis, which, unlike the shaft of the bone, is capable of rapid regeneration. The first osteotomy predated the introduction of anesthetics and was performed in 1826. The surgeon at that time was the American IR Barton. In the following years, however, the method was hardly used. Osteotomy experienced a boom only with the introduction of anesthesia and asepsis. In the second half of the 19th century, B. Langenbeck and T. Billroth in particular shaped the correction osteotomy. At the same time, a chisel was inserted into the osteotomy.

Corticotomy and compactotomy must be distinguished from osteotomy. In these procedures, the bone cortex is severed while sparing the medullary vessels and the periosteum of the bone. Corrective osteotomies are now mainly used to rearrange mishealed fractures or to relieve the parts of a specific joint.

Function, effect & goals

Oscillating saws, Gigli saws, sharp chisels or osteotomy are mainly used for corrective osteotomy. In the case of osteotomies near the hip joint, K-wires mark the position of the correction in advance and allow the correction angle to be determined. In the case of an osteotomy, the created gap is spread open using a distractor.

Each osteotomy concludes with an osteosynthesis , which reconnects the bones in the correct position and ensures bony healing. Plate osteosynthesis is usually used as osteosynthesis . Angle plates are used on some joints . Children are more likely to be fitted with K-wires. In some areas, countersunk screws or Blount staples are also used osteosynthetically. If gaps form during the operation, the gaps are filled with bone graft or artificial bone substitute material. Due to the way the incision is made, osteotomies are intrinsically so stable that no final osteosynthesis is required.

Depending on the surgical procedure, bones can be moved and corrected in all directions of the gap. Length is one of the correction levels. Changes in length occur, for example, as part of shortening or lengthening osteotomies. Rotations are also possible through internal and external rotating osteotomies. The same applies to displacement in the context of translational osteotomies. Tilting into the frontal plane occurs in valgus and varicose vein osteotomies. In contrast, tilting in the sagittal plane constitutes flexing and extending osteotomies. The osteotomy can also have a corrective effect in several directions at the same time, which is necessary, for example, in the case of hip dysplasia or chronic femoral head dissolution.

Four basic types of osteotomy are distinguished. Step and arch osteotomies are extremely rare. Opening and closing osteotomy, which can be implemented in a transverse or oblique form, are used more frequently. According to van Heerwaarden and Marti, corrective osteotomies for the treatment of post-traumatic misalignments thus comprise six groups. The first group is the transverse gap closing wedge osteotomy, in which a foreshortening is created half the width of the base of the wedge of bone to be removed. With this shape, rotation corrections are easy to implement.

In particular, the subcapital of the metatarsal bones are used to correct hallux rigidus. The second group of closing-wedge osteotomy with an oblique gap, with the displacement of bone fragments along the osteotomy, allows correction in two planes and additional shortening or lengthening. The third group of opening wedge osteotomies with a transverse gap allows correction in three planes and is mostly used as intertrochanteric osteotomies to correct hip misalignments. The opening wedge osteotomy with an inclined gap also allows correction in three planes.

This is to be distinguished from the stepped or distraction osteotomy, which is often used to correct thigh bones in three planes . The arcuate osteotomy enables corrections of angulations with intrinsically high stability and is used for elbow misalignment after certain upper arm fractures.

Risks, side effects & dangers

As a surgical procedure, the corrective osteotomy is associated with general surgical risks. Bleeding , secondary bleeding , infection of the surgical wound and damage to the adjacent tissue structures are among these risks. In addition, osteotomies are usually associated with a period of immobility.

Due to the immobility, thrombi can develop, especially in the leg veins, which are associated with the risk of a pulmonary embolism. Anesthesia also carries risks. Anesthesia causes nausea or vomiting in more than half of all patients . In addition, the anesthetic can cause disturbances in the cardiovascular system , which in rare cases can cause cardiac arrest . Because of the artificial respiration during the procedure, some patients later suffer from hoarseness or difficulty swallowing . There are specific risks of corrective osteotomies when used in the hip area, for example in different leg lengths.

In rare cases, the fixations used to stabilize the bone break, necessitating a second operation. As soon as the material wears out, the fixations must be renewed. Some patients also complain of pressure pain due to the fixations. In extreme cases, allergic reactions can occur due to the materials used. In such cases, replacement of the materials within another operation is required.

Website | + posts

Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.