An osteotomy is a surgical intervention, the purpose of which is to restore lost musculoskeletal functions through artificial bone dissection. In most cases, it is used to eliminate limb deformation, which allows you to restore the patient's ability to self-care and move.
General concepts
The osteotomy operation is performed by highly qualified trauma surgeons. At first glance, it seems that the intervention is complex and requires a lot of time to recover the patient, however, following the recommendations of doctors will quickly raise the patient to his feet.
An osteotomy is an operation that is carried out with the help of special tools - osteotomes, Jigley saws, electric saws and ultrasound devices. They help to make holes at the site of the intervention and dissect the bone tissue. After collecting debris, bone fragments are fixed with screws, knitting needles, plates. Unlike accidental fractures, a plaster cast is rarely applied to avoid possible development of contractures in the joints.
Classification
Depending on the nature of operative access, the following types of osteotomy are distinguished:
- Open - requires wide access to bone tissue. After a cut of the skin, subcutaneous tissue and muscle system, the periosteum is separated with a raspator, then the bone is dissected. The debris is fixed in physiological position, on top - a plaster cast.
- Closed - conducted through access to a few centimeters. Muscles do not cut, but exfoliate to get to the bone tissue. With the help of a chisel, the periosteum is separated and a few blows of the hammer on the handle dissect the bone. The vessels and nerves are moved away and fixed with special tools to avoid damage to them. Most often used for transverse osteotomy.
The following interventions are distinguished by the shape of the section:
- transverse;
- staircase;
- oblique;
- zigzag;
- articulated (spherical, arched, wedge-shaped, angular).
Depending on the goal, surgical intervention is of the following types:
- corrective osteotomy;
- derotational;
- aimed at changing the length of the limb;
- aims to improve support function.
Indications for intervention
An osteotomy is an orthopedic operation that is performed in the following cases that are not amenable to conservative therapy:
- congenital or acquired abnormalities and deformations of bone tissue, to a greater extent long tubular bones (thigh, shoulder, lower leg);
- ankylosis - the inability of the joint to function due to the presence of adhesions of the connective tissue, cartilage or bone nature of the articular surfaces;
- congenital hip dysplasia (dislocation);
- fractures that are incorrectly fused;
- osteomyelitis;
- the presence of neoplasms or metastases;
- a history of rickets;
- arthroplasty;
- other congenital malformations of the musculoskeletal system.
The operation is also used in the cosmetic field: osteotomy of the nose, correction of facial contours, 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;
- the period of bearing a child;
- renal or liver failure;
- the presence of a rash of a purulent or other nature in a place where it is necessary to conduct prompt access.
Advantages and disadvantages
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, and remove joint surfaces. The disease stops its progression.
The disadvantage is the possibility of visual asymmetry of the limbs or joints. Moreover, if the patient needs endoprosthetics with joint replacement, then it will be more difficult to carry out after an osteotomy.
Possible complications
An osteotomy is an operation that has been perfected over the years to reduce the risk of postoperative complications. However, any interference of extraneous factors into 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 type of osteotomy can be:
- infection of a postoperative wound - requires the appointment of shock 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 appointed that contain the necessary trace elements (calcium, phosphorus, magnesium, zinc);
- formation of a false joint - additional intervention is required;
- paresthesia - a 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 independently);
- implant rejection - endoprosthetics are necessary.
Corrective osteotomy
A similar procedure is used for improperly healed fractures, congenital defects in bone tissue, the development of ankylosis or pseudoarthrosis, deformation 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 future dissection, and the general condition of the bone tissue. If necessary, conduct computed or magnetic resonance imaging. The remaining examinations are assigned individually by the traumatologist.
The operation is carried out in specialized hospital conditions. The duration of the intervention is about 3-4 hours, which depends 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 structure used in the field of traumatology and orthopedics to fix, compress or stretch fragments of bone tissue 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 the correction of pathological conditions include:
- severe pain syndrome that does not stop with conventional analgesics;
- damage to the external parts of the apparatus or metal structures;
- the development of bleeding;
- hematoma formation;
- displacement of bone fragments relative to each other in any of the planes;
- other complications of a general nature.
Osteotomy in dentistry and maxillofacial surgery
In the dental field, an osteotomy of the jaw is performed, which can act as an independent operation or as a stage of surgical intervention. Used for displacements or fractures, to correct malocclusion. Incisions are made along the jaw behind the molars.
After fixing the jaw in a physiological position, a pressure bandage is applied, fixing the area of the cheeks and chin. Antibiotic therapy is immediately prescribed to avoid the development of suppuration and the formation of osteomyelitis. Between the teeth, several gum is applied, the location of which is monitored daily by a specialist. The sutures are removed after 2 weeks, and the screws holding the jaw in a month to complete the treatment phase with subsequent orthodontic therapy.
In the field of maxillofacial surgery, a nasal osteotomy is used, which is part of rhinoplasty. Indications for are:
- significant curvature of the nasal bridge;
- large bone size;
- the need for bone displacement in relation to the nasal septum.
When performing a nasal osteotomy, aesthetic tasks lie with the surgeon: closing the nasal arch, eliminating the hump and straightening the curvature of the back, narrowing the side 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 osteotomy of the nose:
- 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 necessary amount of surgical treatment.
Any osteotomy should be carried out after raising the level of immunity. This will serve as a preventive measure for the development of complications and will create conditions for good and proper bone fusion.