Osteotomy is a surgical intervention, the purpose of which is to restore lost musculoskeletal functions by artificially cutting the bone. In most cases, it is used to eliminate deformities of the limbs, which allows you to return the patient's ability to self-care and movement.
General concepts
Osteotomy surgery is performed by highly qualified trauma surgeons. At first glance, it seems that the intervention is complicated and requires a lot of time to recover the patient, but following the recommendations of doctors will quickly get the patient back on his feet.
Osteotomy is an operation that is performed with the help of special instruments - osteotomes, Jigli saws, electric saws and ultrasonic devices. They help to make holes at the site of intervention and dissect the bone tissue. After collecting the fragments, bone fragments are fixed with screws, knitting needles, and plates. Unlike accidental fractures, a cast is rarely applied to avoid the possible development of contractures in the joints.
Classification
Depending on the nature of the operational access, the following types of osteotomy are distinguished:
- Open - requires wide access to bone tissue. After the incision of the skin, subcutaneous tissue and muscular apparatus, the periosteum is separated with a raspator, then the bone is dissected. The fragments are fixed in a physiological position, with a plaster cast on top.
- Closed - carried out through an access of several centimeters. The muscles are not cut, but stratified to get to the bone tissue. With the help of a chisel, the periosteum is separated and the bone is dissected with a few blows of the hammer on the handle. Vessels and nerves are moved aside and fixed with special instruments to avoid damage. More commonly used for transverse osteotomies.
The following interventions are distinguished according to the shape of the dissection:
- transverse;
- stair;
- oblique;
- zigzag;
- articulated (spherical, arcuate, wedge-shaped, angular).
Depending on the goal, surgery is of the following types:
- corrective osteotomy;
- derotational;
- aimed at changing limb length;
- aimed at improving the support function.
Indications for intervention
Osteotomy is an orthopedic operation that is performed in the following cases that are not amenable to conservative therapy:
- congenital or acquired anomalies and deformities of bone tissue, mostly long tubularbones (thigh, shoulder, lower leg);
- ankylosis - the impossibility of functioning of the joint due to the presence of adhesions of the connective tissue, cartilage or bone nature of the articular surfaces;
- congenital hip dysplasia (dislocation);
- fractures that healed incorrectly;
- osteomyelitis;
- presence of neoplasms or metastases;
- consequences of rickets in history;
- arthroplasty;
- other congenital anomalies of the musculoskeletal system.
The operation is also used in the cosmetic field: osteotomy of the nose, correction of the oval of the face, impaired jaw functions.
Contraindications
There are a number of factors in the presence of which surgery is delayed:
- infectious diseases at the time when a bone osteotomy is needed or two weeks before surgery;
- diseases of the respiratory and cardiovascular system in the stage of decompensation;
- diabetes mellitus;
- bearing period;
- kidney or liver failure;
- the presence of a purulent or other rash in the place where it is necessary to carry out operational access.
Pros and cons
The positive aspects of the intervention are the weakening of the pain syndrome (if any) and the restoration of motor functions. For example, an osteotomy of the knee joint will eliminate pain during movement, resume flexion and extensor functions, remove articular adhesions.surfaces. The disease stops its progression.
The disadvantage is the possibility of visual asymmetry of the limbs or joints. Moreover, if the patient needs arthroplasty with joint replacement, it will be more difficult to carry out after osteotomy.
Possible Complications
Osteotomy is an operation that has been perfected over the years to reduce the risk of postoperative complications. However, any intervention of extraneous factors in the human body is a source of increased danger, because in addition to the qualifications of the operating specialist, we are talking about the individual characteristics of the patient's body.
Complications of any kind of osteotomy can be:
- infection of the postoperative wound - requires the appointment of loading doses of antibiotic therapy;
- displacement of fragments and fragments of bone tissue - reposition is carried out with further fixation;
- slow bone fusion - multivitamin complexes are prescribed that contain the necessary trace elements (calcium, phosphorus, magnesium, zinc);
- formation of a false joint - additional intervention required;
- paresthesia - violation of the sensitivity of the skin at the site of surgery due to the intersection of nerve branches (does not require additional treatment, recovers on its own);
- implant rejection - endoprosthetics needed.
Corrective osteotomy
Carrying out a similar procedure is used for an incorrectly healed fracture,congenital defects in bone tissue, the development of ankylosis or false joints, deformities of the bones of the foot with impaired motor function, to eliminate visual cosmetic defects.
Before the intervention, an X-ray examination is performed to clarify the location of the bone, the place of the future dissection, and the general condition of the bone tissue. If necessary, computed or magnetic resonance imaging is performed. The remaining examinations are prescribed by the traumatologist individually.
The operation is performed in specialized hospital conditions. The duration of the intervention is about 3-4 hours, depending on the volume of necessary procedures. After dissection of the bone, the fragments are fixed with the Ilizarov apparatus (the operation is performed on the limbs) or with special metal devices that are inserted directly into the bone (foot osteotomy).
The Ilizarov Apparatus is a special device used in the field of traumatology and orthopedics to fix, compress or stretch bone fragments in the required position for a long period of time.
After the operation, a control x-ray is taken to determine the correct fixation.
Complications of corrective osteotomy
Possible complications after correction of pathological conditions include:
- severe pain syndrome, not relieved by conventional analgesics;
- breakage of external parts of the apparatus or metal structures;
- developmentbleeding;
- hematoma formation;
- displacement of bone fragments relative to each other in any of the planes;
- other general complications.
Osteotomy in dentistry and maxillofacial surgery
In the dental field, osteotomy of the jaw is performed, which can act as an independent operation or as a stage of surgical intervention. It is used for displacements or fractures, to correct malocclusion. The incisions are made along the jaw behind the molars.
After fixing the jaw in a physiological position, a pressure bandage is applied to fix the area of the cheeks and chin. Antibiotic therapy is immediately prescribed to avoid the development of suppuration and the formation of osteomyelitis. Several elastic bands are placed between the teeth, the location of which is monitored daily by a specialist. The sutures are removed after 2 weeks and the jaw screws after a month to complete the treatment phase of subsequent orthodontic therapy.
In the field of maxillofacial surgery, osteotomy of the nose is used, which is part of rhinoplasty. Indications for carrying out are:
- significant curvature of the bridge of the nose;
- large bone size;
- necessity to move the bones in relation to the nasal septum.
When performing a nasal osteotomy, the surgeon is responsible for aesthetic tasks: closing the roof of the nose, eliminating the hump and straightening the curvature of the back, narrowingside walls. The specialist should take into account that the dissection of bone tissue can affect the patency of the upper respiratory tract, therefore, during the operation, the anatomical and physiological characteristics of a particular patient are taken into account.
Types of nasal osteotomy:
- lateral (marginal), carried out by perforation or linear method;
- medial (center);
- top;
- intermediate.
The type of intervention used is selected individually, taking into account the patient's problem, the purpose of the operation, the condition of the bone tissue, the required amount of surgical treatment.
Any osteotomy should be done after the immune system has been raised. This will serve as a preventive measure for the development of complications and will create conditions for good and proper fusion of bone tissues.
