• Skip to main content
  • Skip to primary sidebar
  • Skip to footer
  • General Ortho
  • Procedures
  • Spine
  • Upper Limb
  • Lower Limb
  • Pain
  • Trauma
  • Tumors
  • Newsletter/Updates
  • About Us
  • Contact Us

Bone and Spine

Orthopedic health, conditions and treatment

Osteotomy Procedure and Indications

By Dr Arun Pal Singh

In this article
    • Indications for Osteotomy
      • Growth Discrepancy
      • Deformity following Malunion
      • Rotational Deformities
      • Limb Length Discrepancy
      • Dysplasia Correction
    • Contraindications
    • Principles
    • Planning of the Procedure
    • Types of Osteotomies
      • Transverse
      • Oblique
    • Wedge Osteotomy
    • Fixation of Osteotomies

An osteotomy is a surgical procedure where the bone is cut to change its length or alignment. Often the procedure is done in an attempt to correct an abnormality that has resulted from trauma or disease.

The procedure is able to correct the following deformities.

  • valgus/varus angulation
  • anterior/posterior angulation
  • internal/external rotation
  • lengthening/shortening
  • medial/lateral shift
  • dorsal/ventral shift

An osteotomy corrects the biomechanical alignment of the extremity, increases the contact area or improves joint congruence and restores the biomechanical advantage.

Indications for Osteotomy

Growth Discrepancy

Growth disturbances may be caused by trauma, disease, or genetic predisposition, often due to the premature closure. This is especially a problem in forearm and legs where two bones are present. The unaffected bone continues to lengthen while the damaged bone lengthens at a slower rate, the normal bone will be forced to bow away from the shortened bone leading to deformity and altered joint orientation.

Osteotomy is necessary to straighten the deformity and return the limb to a normal function and appearance.

Similarly, trauma a portion of a growth plate may result in a selective slowing or cessation of growth on that side while growth is normal on the unaffected side of the same bone. For example, trauma to the lateral side of the distal radial physis results in valgus deformity if the wrist. Osteotomy through the site of maximal deformity is necessary to return the bone to the normal anatomical position.

Deformity following Malunion

Diaphyseal and metaphyseal fractures may unite in malposition resulting in angular, rotational, or shortened positions requiring osteotomy.

Rotational Deformities

These may occur following trauma or due to a congenital condition such as tibial torsion. Osteotomy may be necessary in severe cases affecting limb function.

Limb Length Discrepancy

In limb lengthening surgeries,  osteotomy may be performed so as bone ends could be distracted by using hardware like Ilizarov external fixator.

Dysplasia Correction

For example in hip dysplasia. Usually performed early before setting in of arthritic changes.

Contraindications

  • Neuropathic Arthropathy
  • Inflammatory Arthropathy
  • Active Infections
  • Severe Osteopenia
  • Advanced Arthritis

Principles

  • Accurate alignment and reduction of the osteotomy gap must be accomplished
  • Rigid fixation, using internal fixation or external fixation must be provided
  • Soft tissues must be carefully protected

Planning of the Procedure

It is important to plan the procedure to minimize any chance for error.

Preoperative radiographs in at least two views should be taken of both the affected bone or bones and the normal unaffected contralateral limb. Radiographs must include the entire joint above and below the deformed bone. The rotational deformity can be missed on radiographs and should be measured clinically.

The correction should be planned at the site of the greatest deformity.

The amount of bone resection, angle and plane of osteotomy should be well planned by preoperative drawings.

Types of Osteotomies

Transverse

It is ideal for correction rotation alone in the metaphyseal and diaphyseal region.  The procedure is performed at the area of major rotation by cutting a transverse plane through the bone.  When the transverse osteotomy technique is employed, the fixation is very stable.

Oblique

Oblique osteotomy allows two bones to be separate or lengthened and still allow for point contact. It can also be used to provide rotational correction as well by placing the proximal obliquity into the medullary cavity of the distal fragment, thus providing a pivotal point for derotation and varus or valgus realignment

Wedge Osteotomy

Wedge Osteotomy
Wedge Osteotomy, Image Credit: Orthopale, http://www.orthopale.com/images/HTVO-techniques.jpg

Also called cuneiform osteotomy, wedge osteotomy is used primarily to correct angular deformity, but may be used for angular and rotational problems if both exist simultaneously.

It is of following types

Open Wedge

The cut is made at the desired site and a bone wedge is inserted on the concave surface. It results in bone lengthening.

Closing Wedge Osteotomy

A predetermined size of the wedge of bone is removed from the point of maximal deformity with the base of the wedge is at the convex surface of the deformity. The gap is then closed, correcting the angulation and fixed. It results in slight bone shortening.

Fixation of Osteotomies

Osteotomies can be stabilized using all conventional forms of internal or external fixation.

It could be

Internal fixation – plating, screws, K-wire fixation, tension band wiring

External fixation – Tubular fixator, Ilizarov fixator

Spread the Knowledge
  • 6
    Shares
  •  
    6
    Shares
  • 6
  •  
  •  
  •  
  •  

Filed Under: Procedures

About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

Reader Interactions

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Primary Sidebar

Calcaneus anatomy

Calcaneus Anatomy and Attachments

Calcaneus is bone of the hindfoot and is the largest tarsal bone. Calcaneus forms the prominence of the heel. Structure of Calcaneus Calcaneus is roughly cuboidal in shape. It is directed forwards, upwards and laterally. It has six surfaces. Anterior Surface The anterior surface is the smallest surface of the bone. It is covered by […]

vertebroplasty

Vertebroplasty and Kyphoplasty

Vertebroplasty is a medical spinal procedure where the fractured vertebra is approached percutaneously [After making a small hole in the skin] and then injecting cement into the fractured vertebra. The procedure was introduced to relieve the pain of osteoporotic fractures. Initial studies suggested that vertebroplasty provided effective relief of pain but the studies that followed […]

Imaging of spine MRI

Imaging in Spinal Disorders

In modern spine practice, imaging has a pivotal role in the diagnosis and treatment of the lesion. In this article, we discuss various modalities of imaging of spine disorders. X-rays Conventional plain film radiography initiates the investigation of any suspected spinal pathology. X-ray is the basic investigation, not that sensitive albeit. X-ray has a very […]

Different Types of Bone Destruction

Bone Destruction- Patterns and Their Significance

Different patterns of bone destruction as observed on x-rays are caused by a variety of disease processes affecting the bone. Different types of destructions suggest the intensity and aggression of the disease process. Classically, x-rays were used for imaging and diagnosis. With the advent of CT and MRI, the x-ray diagnosis of lesions has lost […]

selective nerve root blocks

Selective Nerve Root Block – Indications and Applications

Selective nerve root block is similar in approach to facet joint injections but they address different pathologies. Both of these might be used in the same patient for the diagnostic purpose [to find if the pain is due to facet joint or nerve root] but as therapeutic measure, they address different issues. As in epidural […]

Joint Orientation Lines

Normal Alignment of Lower Limb – Axes and Orientation

To understand the deformities of the lower limb, it is important to grasp and establish the parameters defining normal alignment. The normal alignment of lower limb is governed by the arrangement of the femur, tibia, hip, knee, and ankle. To understand it better, the complex three-dimensional shapes of bones and joints can be simplified to basic […]

Crush injury upper limb resulting in partial amputation

Mangled Extremity Severity Score

The Mangled extremity severity score is used in patients with trauma to a limb, particularly lower extremity trauma. As the name suggests, it determines how badly the injured limb is. The score applied to mangled extremities such as limbs overrun by vehicles. It was developed to discriminate between salvageable and the limbs which would require […]

Browse Articles

Footer

Pages

  • About
    • Policies
    • Contact Us

Featured Article

Fractures of Talus Bone

Fractures of the talus include a broad spectrum of injuries from occult fractures of the talar process to displaced talar neck fractures.Talar … [Read More...] about Fractures of Talus Bone

Search Articles

© Copyright: BoneAndSpine.com