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Facial Plastic Surgery Clinics of North... Feb 2021For rhinoplasty surgeons, surgery of the dorsum has never been so dynamic or as easily learned. Reproducible techniques offer excellent results that can be difficult to... (Review)
Review
For rhinoplasty surgeons, surgery of the dorsum has never been so dynamic or as easily learned. Reproducible techniques offer excellent results that can be difficult to achieve in certain patients using component reduction. An expanding repertoire of dorsal preservation (DP) techniques is evolving. Each DP operation builds on the others. To understand DP requires a new appreciation of the cartilaginous septum, the perpendicular plate of ethmoid, nasal osteotomies, and anatomy of the nose where surgeons do not operate with traditional component reduction. The result is more beautiful noses where the normal anatomy is preserved.
Topics: Humans; Nasal Cartilages; Nasal Septum; Osteotomy; Practice Patterns, Physicians'; Rhinoplasty
PubMed: 33220835
DOI: 10.1016/j.fsc.2020.09.001 -
The Journal of Craniofacial SurgeryHorizontal osteotomy is one of the most critical step at sagittal split ramus osteotomy (SSRO) and determination of the ideal height of this horizontal osteotomy is...
UNLABELLED
Horizontal osteotomy is one of the most critical step at sagittal split ramus osteotomy (SSRO) and determination of the ideal height of this horizontal osteotomy is essential to avoid nerve and vessel injury.
PURPOSE
The aim of this study was to evaluate the level of the medial horizontal ramus cut as a risk factor for unfavorable outcomes in the SSRO.
MATERIALS AND METHODS
Sixty-four patients with dentofacial deformity who applied to Oral & Maxillofacial Surgery Department between August 2018 and August 2019 and undergone orthognathic surgery were evaluated. Out of 64, 49 patients had SSRO with or without maxillary surgery and genioplasty. Twenty-six patient had postoperative computed tomography scan with 6-months follow-up. Finally, 26 patient with 52 SSRO sides were included in this study. Computed tomography scans were evaluated and classification according to osteotomy levels was made. Postoperative neurosensory deficit, bleeding, and intraoperative complications such as bad split, visible damage to inferior alveolar bundle were assessed. Age, gender, neurosensory deficit, bad splits were analyzed and correlated with the level of the osteotomies.
RESULTS
Fifteen osteotomies were above lingula, 24 between apex and base of lingula, and 14 below lingula. One bad split occurred, and no visible damage to the inferior alveolar bundle was seen. There was no significant difference between osteotomy groups in terms of visual analogue scale (VAS) scores (P > 0.05) but in all groups; women's VAS scores are statistically significantly higher than men. (P: 0.036).
CONCLUSION
There is no correlation between the horizontal osteotomy level and intraoperative or postoperative complications. The low medial horizontal osteotomy can be safely performed in SSRO.
Topics: Female; Genioplasty; Humans; Male; Mandible; Orthognathic Surgical Procedures; Osteotomy, Sagittal Split Ramus; Tomography, X-Ray Computed
PubMed: 33405452
DOI: 10.1097/SCS.0000000000007404 -
Der Orthopade Jul 2021Complex deformities around the knee joint are usually severe and have several aetiologies. They can be present in one or more planes, with variations in severity between... (Review)
Review
Complex deformities around the knee joint are usually severe and have several aetiologies. They can be present in one or more planes, with variations in severity between planes. The occurrence and progression of the deformity can be influenced by local and systemic factors. Several types of osteotomies and fixation methods are available to correct these complex deformities. The selection of the osteotomy used to correct a deformity depends on the type of deformity, its severity and its aetiology. Therefore, precise planning taking into consideration the above factors is necessary to achieve the goal.
Topics: Humans; Knee Joint; Osteotomy
PubMed: 34160640
DOI: 10.1007/s00132-021-04117-5 -
Foot (Edinburgh, Scotland) Dec 2022At the time of the first report on the feasibility of corrective osteotomies of the distal phalanx (DP) of the great toe there were no published studies addressing this... (Review)
Review
BACKGROUND
At the time of the first report on the feasibility of corrective osteotomies of the distal phalanx (DP) of the great toe there were no published studies addressing this type of surgery. Along this line, and throughout our clinical experience, this paper tries to show the clinical benefits of hallux DP osteotomies when correcting interphalangeal valgus deformities (IHV) of the great toe, either with open or percutaneous procedure.
MATERIAL AND METHODS
This is a review of 18 cases in which a DP osteotomy was performed in 2 different institutions, 8 cases were performed using open technique and 10 cases percutaneously. The correction obtained was analyzed by measuring the distal articular set angle (DASA), obliquity angle (AP1), asymmetry angle (AP2), and global distal phalanx deviation (GDPD) angle before and after the surgery on dorso-plantar weight-bearing radiographs in all cases. Clinical results were also recorded.
RESULTS
Excellent clinical and radiological results were achieved with both techniques in all patients with no complications. The average DP angular deformity correction in terms of AP1, AP2 and GDPD angles were 4.58º ± 5.55º, 8.95º ± 4.77º and 16.53º ± 7.26 respectively. In 10 cases an Akin osteotomy was associated.
CONCLUSION
In cases with valgus deviation in the hallux DP, a corrective osteotomy of the DP alone or associated to osteotomy of the PP should be considered as a useful tool. The technique is feasible and has no technical difficulties for an orthopedic surgeon with experience on feet surgery.
Topics: Humans; Hallux Valgus; Osteotomy; Hallux; Radiography; Weight-Bearing; Retrospective Studies; Treatment Outcome
PubMed: 36037778
DOI: 10.1016/j.foot.2022.101935 -
Annals of the Royal College of Surgeons... Jan 2022Akin osteotomies are commonly fixed with a screw or staple. Hardware-related symptoms are not uncommon. We compared the outcomes and costs of the two implants. (Comparative Study)
Comparative Study
INTRODUCTION
Akin osteotomies are commonly fixed with a screw or staple. Hardware-related symptoms are not uncommon. We compared the outcomes and costs of the two implants.
METHODS
We evaluated 74 Akin osteotomies performed in conjunction with first metatarsal osteotomy for hallux valgus. The osteotomy was fixed with a headless compression screw in 39 cases and a staple in 35 cases. We looked at the implant-related complications, removal of metalwork, revision, non-union and cost. Pre- and postoperative hallux valgus interphalangeal (HI) angles and length of the proximal phalanx were measured.
RESULTS
There was 100% union, no failure of fixation, no revision surgery and no delayed union in either group. The radiological prominence of screws was significant (=0.02), but there was no significant difference in soft-tissue irritation (=0.36) or removal of implants (=0.49). Two cortical breaches (5.8%) occurred in staple fixation and 4 (10.2%) in screw fixation (not statistically significant (NS), =0.50). The mean improvement in HI angle was 4.3° with screw fixation and 4.1° with staple fixation (NS, =0.69). The mean shortening of the proximal phalanx was 2.5mm with screw fixation and 2.3mm with staple fixation (NS, =0.64). The total cost was £1,925 for staple fixation and £4,290 for screw fixation.
CONCLUSIONS
Staple and screw fixation are reproducible modalities with satisfactory outcomes, but screw fixation is expensive. We conclude staple fixation is a cost-effective alternative.
Topics: Bone Screws; Female; Hallux Valgus; Humans; Male; Metatarsal Bones; Middle Aged; Osteotomy; Retrospective Studies; Sutures
PubMed: 34323127
DOI: 10.1308/rcsann.2021.0029 -
The Journal of Craniofacial Surgery Jun 2020To review the specific techniques of closing wedge osteotomy and open osteotomy, compare their clinical and radiographic outcomes, and apply these findings to mandibular...
PURPOSE
To review the specific techniques of closing wedge osteotomy and open osteotomy, compare their clinical and radiographic outcomes, and apply these findings to mandibular reconstruction.
METHODS
A thorough review of the otolaryngology, facial plastic and reconstructive surgery, oral and maxillofacial surgery, and orthopedic surgery literature was conducted in the Ovid MEDLINE, EMBASE, and Google Scholar databases using the terms 'osteotomy' and 'mandibular reconstruction.'
RESULTS
Traditionally, open osteotomies were thought to result in greater rates of malunion. However, multiple meta-analyses within the orthopedic literature have refuted this. Closing wedge osteotomies, on the other hand, may increase the chance of damaging a perforator. Again, no studies have evaluated the relationship between type of osteotomy and flap survival or wound healing. The particular type of osteotomy performed often depends on the type of osseous flap being utilized.
CONCLUSIONS
Open osteotomies are a viable and even preferred alternative, particularly in flaps without consistent perforators, such as scapular free flaps.
Topics: Humans; Mandibular Reconstruction; Osteotomy; Surgical Flaps
PubMed: 32282471
DOI: 10.1097/SCS.0000000000006344 -
Journal of the American Podiatric... Apr 2022Midfoot osteotomy is often used in the surgical treatment of foot deformities. The percutaneous Gigli saw osteotomy (PGSO) technique has many advantages compared with...
BACKGROUND
Midfoot osteotomy is often used in the surgical treatment of foot deformities. The percutaneous Gigli saw osteotomy (PGSO) technique has many advantages compared with known osteotomy techniques. We aimed to show the efficacy and reliability of the PGSO technique in the midfoot of fresh frozen cadavers without using an image intensifier.
METHODS
Four mini-incisions were performed on the dorsomedial, dorsolateral, plantar medial, and plantar lateral regions of the midfoot. Subperiosteal tunnels were then opened with a thin bone elevator, and the four incisions were combined with each other. The Gigli saw was tied to suture material and passed through the tunnels. The PGSO was performed in the midfoot of 12 feet of the cadaver specimens without using an image intensifier. Cadaver specimens were dissected, and injured structures were noted.
RESULTS
The mean ± SD (range) cadaver age was 81.16 ± 10.38 years (65-93 years) and weight was 60.86 ± 12.39 kg (49.8-81.6 kg). All of the osteotomies were adequate as planned in the cuboid-cuneiform level and all of them were complete osteotomy .Incomplete osteotomy was not observed in any cadaver specimens. In one specimen, a complete injury of the peroneal tendons (peroneus longus and brevis) was detected. In another specimen, an incomplete tibialis anterior tendon injury was detected. There was no iatrogenic neurovascular injury in the specimens.
CONCLUSIONS
The PGSO technique is recommended for use even by inexperienced surgeons owing to its minimal risk of soft-tissue injury, provision of a complete osteotomy line, and easy application with limited incisions.
Topics: Aged; Aged, 80 and over; Cadaver; Foot; Foot Deformities; Humans; Osteotomy; Reproducibility of Results
PubMed: 36115041
DOI: 10.7547/20-156 -
Operative Orthopadie Und Traumatologie Oct 2023Restoration of the original anatomy with reduction of both current symptoms and risk of posttraumatic osteoarthritis. (Review)
Review
OBJECTIVE
Restoration of the original anatomy with reduction of both current symptoms and risk of posttraumatic osteoarthritis.
INDICATIONS
Symptomatic intra- or extra-articular malunion due to limitation of movement and/or painful function, intra-articular step of > 1 mm, instability of the distal radioulnar joint.
CONTRAINDICATIONS
Minimal deformity. Pre-existing osteoarthritis Knirk and Jupiter II or higher. Simpler surgical alternative, e.g., ulna shortening osteotomy. Smoking or advanced age are not contraindications.
SURGICAL TECHNIQUE
Preoperative assessment and performance of a bilateral computed tomography (CT). Three-dimensional (3D) malposition analysis and calculation of the correction. Planning of the corrective osteotomy on the 3D model and creation of patient-specific drilling and sawing guides. Performing the 3D-guided osteotomy.
POSTOPERATIVE MANAGEMENT
Early functional unloaded mobilization with the splint for 8 weeks until consolidation control with CT.
RESULTS
Significant reduction of the step to < 1 mm (p ≤ 0.05) can be achieved with intra-articular corrections. In extra-articular corrective osteotomies, a mean residual rotational malalignment error of 2.0° (± 2.2°) and a translational malalignment error of 0.6 mm (± 0.2 mm) is achieved. Single-cut osteotomies in the shaft region can be performed to within a few degrees for rotation (e.g., pronation/supination 4.9°) and for translation (e.g., proximal/distal, 0.8 mm). After surgery, a mean residual 3D angle of 5.8° (SD 3.6°) was measured. Furthermore, surgical time for 3D-assisted surgery is significantly reduced compared to the conventional technique (140 ± 37 vs 108 ± 26 min; p < 0.05). Thus, the progression of osteoarthritis can be reduced in the medium term and improved mobility and grip strength are achieved. The clinical outcome parameters based on patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) scores are roughly comparable.
Topics: Humans; Radius; Radius Fractures; Treatment Outcome; Fractures, Malunited; Osteotomy; Osteoarthritis; Range of Motion, Articular
PubMed: 37129610
DOI: 10.1007/s00064-023-00808-8 -
Foot and Ankle Clinics Sep 2020Minimally invasive distal metatarsal diaphyseal osteotomy (DMDO) is an effective procedure for the treatment of complicated chronic diabetic foot ulcers under the heads... (Review)
Review
Minimally invasive distal metatarsal diaphyseal osteotomy (DMDO) is an effective procedure for the treatment of complicated chronic diabetic foot ulcers under the heads of all lateral metatarsal bones (including the fifth). Resistant toe ulcers and recurrent pressure ulcers can be treated effectively by DMDO. For diabetic patients, the main advantages of this method are minimal surgical scars and tissue damage, immediately postoperative weight bearing, absence of osteosynthesis and consequent potential infection of metal fixation, reduction of the previous high plantar pressures by the restoration of a harmonic balanced forefoot arch, and rapid ulcer healing.
Topics: Diabetic Foot; Humans; Metatarsal Bones; Minimally Invasive Surgical Procedures; Osteotomy
PubMed: 32736741
DOI: 10.1016/j.fcl.2020.05.006 -
Arthroscopy : the Journal of... Mar 2024Medial opening-wedge high tibial osteotomies are commonly performed to treat varus deformity and medial compartment osteoarthritis of the knee in active younger...
Editorial Commentary: Risk of Lateral Hinge Fracture After Knee Medial Opening-Wedge High Tibial Osteotomy Can Be Reduced With Osteotomy at the Level of the Proximal Tibiofibular Joint and Gap Width of No Larger Than 11 mm.
Medial opening-wedge high tibial osteotomies are commonly performed to treat varus deformity and medial compartment osteoarthritis of the knee in active younger individuals. A common complication of this procedure is the development of a lateral hinge fracture. This can occur both acutely and with a delayed presentation. There are many considerations to reduce this fracture, including biplanar versus monoplanar osteotomy, amount of correction/gap width, level of the osteotomy, and lateral cortical distance of the osteotomy. To best reduce the risk of a lateral hinge fracture, place the level of the osteotomy at the level of the proximal tibiofibular joint, and maintain a gap width of no larger than ∼11 mm.
Topics: Humans; Tibia; Tibiofemoral Joint; Osteoarthritis, Knee; Knee Joint; Fractures, Bone; Osteotomy
PubMed: 38219141
DOI: 10.1016/j.arthro.2023.09.010