-
Orthopaedic Surgery Jul 2021Osteoarthritis causes joint pain and functional disorder, of which knee osteoarthritis is the most common. Nowadays, clinically effective treatments mainly include... (Review)
Review
Osteoarthritis causes joint pain and functional disorder, of which knee osteoarthritis is the most common. Nowadays, clinically effective treatments mainly include conservative treatment, arthroplasty, and osteotomy. However, conservative treatment only offers symptomatic relief and arthroplasty is limited to the patients with a moderate to severe degree of osteoarthritis. For relatively young patients who require greater knee preservation, a surgical treatment with low operation trauma and revision rate is needed. Osteotomy around the knee, based on the notion of "knee preservation," has been chosen as an alternative surgical treatment. Cutting and realigning the bones corrects the mechanical line of lower limb force bearing. As such, osteotomy around the knee retains normal anatomical structure and obtains good functional recovery of the knee joint. The techniques of osteotomy around the knee includes anti-varus deformity and anti-valgus deformity osteotomy, aiming to reallocate the force bearing in the compartment of the knee joint. By choosing the surgical section of the lower limbs, the osteotomy around the knee can achieve the correction of mechanical axis, such as the high tibial osteotomy (HTO), proximal fibular osteotomy (PFO), and distal femur osteotomy (DFO). Numerous modified techniques have been developed to meet the demands of patients based on traditional methods. These modified osteotomy have their own advantages and indications. This paper aims to guide clinical treatment by reviewing different types of osteotomies, and their effects, that have been studied and applied widely in clinical practices.
Topics: Humans; Internal Fixators; Osteoarthritis, Knee; Osteotomy
PubMed: 34110088
DOI: 10.1111/os.13021 -
Medicina (Kaunas, Lithuania) Mar 2022Background and Objectives: Tibial malunions are defined as tibial fractures that have healed in a clinically unacceptable position, resulting in deformity such as... (Review)
Review
Background and Objectives: Tibial malunions are defined as tibial fractures that have healed in a clinically unacceptable position, resulting in deformity such as shortening, lengthening, abnormal rotation, or angulation. These deformities can have adverse effects on patients, such as pain and gait disturbance, as well as long term development of post-traumatic arthritis. This paper seeks to highlight some of the options for surgical management of malunions and detail the strategies and approaches used to manage these complicated cases. Materials and Methods: An exhaustive search was conducted on PubMed using the key search terms “Tibial” OR “Tibia” AND “Malunion” to be included in the title. Exclusions to the search included any article with patients aged < 18 years, any nonhuman subjects, and any article not published or translated into English. Results: A systematic review of the literature revealed 26 articles encompassing 242 patients who had undergone surgical correction for tibia malunion. A total of 19 patients suffered from complications. Methods of treatment included osteotomies, with plate and screws, external fixator, angled blade plate, intramedullary nails, Ilizarov fixator, Taylor Spatial Frame, Precise nail, and total knee arthroplasty. Restoring alignment and the articular surface led to overwhelmingly positive patient outcomes. Conclusions: Tibial malunions take many forms, and as such, there are many approaches to correcting deformities. The literature supports the following radiological parameters to diagnose tibial malunion: 5−10 degrees angulation, 1−2 cm shortening, 10−15 degrees internal rotation, and 10−20 degrees external rotation. Surgical plans should be customized to each individual patient, as there are many approaches to tibial malunion that have been shown to be successful in delivering excellent clinical outcomes.
Topics: Adolescent; External Fixators; Fracture Fixation, Intramedullary; Humans; Osteotomy; Tibia; Tibial Fractures
PubMed: 35334565
DOI: 10.3390/medicina58030389 -
Orthopaedics & Traumatology, Surgery &... Feb 2024Lateral metatarsal osteotomy (LMO) aims to reposition the affected metatarsals in a chosen position. The approach may be open or percutaneous. There are several types of... (Review)
Review
Lateral metatarsal osteotomy (LMO) aims to reposition the affected metatarsals in a chosen position. The approach may be open or percutaneous. There are several types of LMO, according to displacement: shortening, raising, translation or lengthening. Preoperative planning covers type and extent of displacement, osteotomy location and type (open or percutaneous), and number of metatarsals concerned. In the 1990s, older concepts of non-fixed osteotomies gave way to preoperative planning and calculated shortening, including the development of Weil shortening osteotomy. Diaphyseal lengthening or shortening osteotomy is mainly used for brachymetatarsia. The older concept of non-fixed lateral rays made a comeback with percutaneous first-ray surgery. Distal metatarsal minimally invasive osteotomy (DMMO) is the most effective, giving rise to variants such as distal oblique metatarsal minimally invasive osteotomy (DOMMO), to meet the requirements of greater displacement, especially in shortening and translation, and to be applicable in as wide a range of cases as possible. Presently, these percutaneous techniques have not demonstrated superiority over open surgery, and entail specific complications. Even so, they are now part of the armamentarium of forefoot surgery, as their minimal invasiveness corresponds to current trends in surgery, especially in the foot. Level of evidence: V.
Topics: Humans; Metatarsal Bones; Metatarsalgia; Minimally Invasive Surgical Procedures; Foot; Osteotomy
PubMed: 38048905
DOI: 10.1016/j.otsr.2023.103782 -
Medicina (Kaunas, Lithuania) Jul 2022A mathematically directed osteotomy (MDO) is a surgical planning technique for correcting long bone deformities. Using a mathematically derived osteotomy plane, the... (Review)
Review
A mathematically directed osteotomy (MDO) is a surgical planning technique for correcting long bone deformities. Using a mathematically derived osteotomy plane, the single-cut correction simultaneously addresses angular deformity, axial malrotation, and minor shortening. This review describes an MDO's indications for use, defines its input and output variables, includes the required graphs for osteotomy planning, and provides intraoperative tips and tricks for successful execution. Finally, the authors present a digital MDO calculator to simplify the complex computations and allow for more precise planning.
Topics: Humans; Osteotomy
PubMed: 35888691
DOI: 10.3390/medicina58070971 -
Neurosurgery Clinics of North America Oct 2023Posterior-based osteotomies are crucial to the restoration of lordosis in adult spinal deformity. Posterior-column osteotomies are suited for patients with an unfused... (Review)
Review
Posterior-based osteotomies are crucial to the restoration of lordosis in adult spinal deformity. Posterior-column osteotomies are suited for patients with an unfused anterior column and non-focal sagittal deformity requiring modest correction in lordosis. When performed on multiple levels, posterior-column osteotomy may provide significant harmonious correction in patients who require more extensive correction. Pedicle subtraction osteotomy and vertebral column resection are appropriate for patients with a fused anterior column and more severe deformity, particularly focal and/or multiplanar deformity. The power of pedicle subtraction osteotomy and vertebral column resection to provide greater correction and to address multiplanar deformity comes at the cost of higher complication rates than posterior-column osteotomy.
Topics: Adult; Animals; Humans; Lordosis; Osteotomy; Neurosurgical Procedures
PubMed: 37718102
DOI: 10.1016/j.nec.2023.06.002 -
Facial Plastic Surgery : FPS Feb 2020An ideal nasal osteotomy should deliver precise, predictable, and reproducible cosmetic and functional results while minimizing soft-tissue trauma and postoperative... (Review)
Review
An ideal nasal osteotomy should deliver precise, predictable, and reproducible cosmetic and functional results while minimizing soft-tissue trauma and postoperative complications. In addition to closing an open roof deformity after hump reduction, other common indications for osteotomies include the crooked nose and a wide bony vault. The literature has reported numerous and diverse osteotomy techniques as well as differences in timing of osteotomies. Each has its own merits and indications, and its proponents. In this article, we review the anatomy and nomenclature relating to osteotomies. We review the locations and paths of the osteotomies-lateral, intermediate, medial, and superior/transverse. We consider the percutaneous and endonasal approaches, as well as timing of osteotomies and other considerations. We also discuss technical considerations in the selection of instrumentation for osteotomies.
Topics: Humans; Nose; Osteotomy; Postoperative Complications; Plastic Surgery Procedures; Rhinoplasty
PubMed: 32191960
DOI: 10.1055/s-0040-1701478 -
The Orthopedic Clinics of North America Jul 2020Lower extremity deformities in children rely on osteotomies for correction. Percutaneous osteotomies offer a method for cutting bone that is advantageous for soft tissue... (Review)
Review
Lower extremity deformities in children rely on osteotomies for correction. Percutaneous osteotomies offer a method for cutting bone that is advantageous for soft tissue healing. These low-energy osteotomies preserve the blood supply to bone, which maximizes the ability of bone to heal. Some of these techniques are technically demanding and should be performed first with an experienced operator. The key to maintaining safety in these osteotomies is to remain in a subperiosteal location. The categories of percutaneous osteotomy include multiple drill hole osteotomy, corticotomy, and Gigli saw osteotomy. This article discusses the advantages and indications for each type of osteotomy.
Topics: Bone and Bones; Child; Humans; Minimally Invasive Surgical Procedures; Musculoskeletal Abnormalities; Osteotomy
PubMed: 32498953
DOI: 10.1016/j.ocl.2020.03.001 -
Journal of Pediatric Orthopedics. Part B May 2023Wiktor Dega has significantly impacted contemporary pediatric orthopedics by developing transiliac osteotomy - Dega's pelvic osteotomy. The global implementation of the...
Wiktor Dega has significantly impacted contemporary pediatric orthopedics by developing transiliac osteotomy - Dega's pelvic osteotomy. The global implementation of the surgery technique gained dynamism in the 2000s after being published by Ward and Grudziak. Since then, derivative operative techniques called Dega, Dega-like or Dega family osteotomies have been developed. We analyzed the original articles published by Dega between 1929 and 1974 concerning transiliac osteotomy technique development and articles about its derivatives. The epidemiological significance of developmental hip dysplasia focused Wiktor Dega's attention in the 1920s. At that time, he treated patients according to König's idea of acetabular roof plastic surgery. The osteotomy depth gradually increased, which allowed deeper graft placement to perform what we nowadays call acetabuloplasty. In 1958, Dega coined the name 'supraacetabular semicircular osteotomy'. It differed from the final concept of the transiliac osteotomy by not assuming the cut of the inner cortex of the iliac bone. The hinge for the acetabular rotation was located at the inner cortex's whole length, disallowing the excessive redirection. The final concept of osteotomy allows for simultaneous acetabuloplasty and redirection to change the shape, location and acetabular volume. Dega derivatives are Mubarak (San Diego) and high Dega osteotomies. Dega osteotomy and its derivates are routinely implemented to treat developmental hip dysplasia and spastic hip disorders. It might be considered an option in Legg-Calve-Perthes disease, congenital deficiencies, and flaccid hip displacement in neurological conditions.
Topics: Child; Male; Humans; Hip Joint; Hip Dislocation, Congenital; Developmental Dysplasia of the Hip; Acetabulum; Osteotomy; Treatment Outcome
PubMed: 36125907
DOI: 10.1097/BPB.0000000000001005 -
Current Opinion in Otolaryngology &... Aug 2023The philosophy of preservation rhinoplasty originated 100 years ago. Many variations have appeared in the last 10 years, with different opinions emerging in the... (Review)
Review
PURPOSE OF REVIEW
The philosophy of preservation rhinoplasty originated 100 years ago. Many variations have appeared in the last 10 years, with different opinions emerging in the literature and scientific meetings.
RECENT FINDINGS
New technological devices (piezo and diamond burs), new anatomical concepts (W and E-points, lateral and dorsal keystone area), and many new surgical strategies have led to a recent revolution in rhinoplasty.
SUMMARY
Preservation rhinoplasty is a surgical strategy/philosophy that has gained popularity among rhinoplasty surgeons. Dorsal preservation rhinoplasty is the 'queen' of preservation rhinoplasty, and an array of surgeons' variations have come about. Ferreira et al. have proposed a classification for dorsal preservation rhinoplasty that splits it into foundation techniques and surface techniques. Foundation techniques are all techniques with impaction osteotomies - push or letdown; in this group, there is always a more minor or significant disruption between the skull and the nasal pyramid. Surface techniques are techniques that work on the surface of the nose (like the traditional structured approaches); in this group, there are no impaction osteotomies, so there is no disruption between the skull and the nose.
Topics: Humans; Rhinoplasty; Nasal Septum; Osteotomy; Esthetics; Skull
PubMed: 37043193
DOI: 10.1097/MOO.0000000000000896 -
Operative Orthopadie Und Traumatologie Apr 2024
Topics: Humans; Treatment Outcome; Knee Joint; Osteotomy
PubMed: 38609502
DOI: 10.1007/s00064-024-00846-w