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Aesthetic Surgery Journal Apr 2023Osteotomy is one of the most traumatic but critical procedures in rhinoplasty. A detailed preoperative analysis of the bony vault is essential to performing a successful...
BACKGROUND
Osteotomy is one of the most traumatic but critical procedures in rhinoplasty. A detailed preoperative analysis of the bony vault is essential to performing a successful osteotomy.
OBJECTIVES
This study aimed to analyze bone thickness along the osteotomy path in primary rhinoplasty patients.
METHODS
Preoperative 3-dimensional facial bone computed tomography images of 250 patients who underwent primary rhinoplasty were analyzed, and their bony vaults categorized based on symmetry. The bone thickness was measured at 3 points along the lateral and at 2 points along the medial and intermediate osteotomy paths.
RESULTS
Of the 250 patients analyzed, 88 (35.2%) had asymmetric and 162 (64.8%) had symmetric bony vaults. The mean thickness of the bony vault was thickest at the middle level of the lateral osteotomy path, and the bony vault was thicker in male patients at all points of medial and lateral osteotomies. Furthermore, in the asymmetric bony vault, the deviated side was thicker than the contralateral side along all osteotomy paths. In particular, the deviated side was thicker, and the contralateral side was thinner, in the asymmetric bony vault than in the symmetric bony vault at the middle level of the lateral osteotomy path.
CONCLUSIONS
The thickness of the bony vault differs according to osteotomy path and gender. The lateral osteotomy, especially at the midpoint of the deviated side in male patients, is crucial in achieving a more controlled fracture.
Topics: Humans; Male; Rhinoplasty; Nasal Bone; Osteotomy; Tomography, X-Ray Computed; Imaging, Three-Dimensional
PubMed: 36594157
DOI: 10.1093/asj/sjac356 -
Clinical Biomechanics (Bristol, Avon) Dec 2023High tibial osteotomy surgery is a widely successful joint-preserving procedure which alters the hip-knee-ankle axis which can delay the progression of osteoarthritis;...
BACKGROUND
High tibial osteotomy surgery is a widely successful joint-preserving procedure which alters the hip-knee-ankle axis which can delay the progression of osteoarthritis; however, conventional osteotomy surgical procedures do not adequately control the posterior tibial slope. This study aimed to determine the key variables influencing posterior tibial slope during high tibial osteotomy and provide a simple means of implementing the findings during pre-operative planning.
METHODS
A virtual cohort of twenty-eight proximal tibia geometries of knee osteoarthritis patients was used in the study. Firstly, absolute posterior tibial slope values were contrasted using anatomical and posterior mechanical axis measurement approaches. Secondly, the influence of variables affecting posterior tibial slope change during osteotomy surgery was investigated using 3D preoperative planning surgical simulation and analytical modelling.
FINDINGS
There was a poor correlation (R = 0.38) between the different clinical measurements of posterior tibial slope; with an average of 7.0 ± 1.3° and 14.8 ± 2.2° respectively. An analytical solution for the change in posterior tibial slope was derived based on the hinge axis angle and the osteotomy opening angle. For three different opening angles (6°, 9° and 12°) and seven different hinge axis orientations (-30° to +30°), the results obtained were identical for the analytical model and the 3D preoperative planning.
INTERPRETATION
This study determined that the key variables affecting posterior tibial slope during high tibial osteotomy are the osteotomy opening angle and the hinge axis orientation. The derived formula provides a simple means of determining the change in posterior tibial slope resulting from a particular surgical approach.
Topics: Humans; Tibia; Knee Joint; Osteoarthritis, Knee; Knee; Osteotomy
PubMed: 37922607
DOI: 10.1016/j.clinbiomech.2023.106125 -
International Journal of Computer... Dec 2023The use of MRI scans for pre-operative surgical planning of forearm osteotomies provides additional information of joint cartilage and soft tissue structures and reduces...
INTRODUCTION
The use of MRI scans for pre-operative surgical planning of forearm osteotomies provides additional information of joint cartilage and soft tissue structures and reduces radiation exposure in comparison with the use of CT scans. In this study, we investigated whether using 3D information obtained from MRI with and without cartilage information leads to a different outcome of pre-operative planning.
METHODS
Bilateral CT and MRI scans of the forearms of 10 adolescent and young adult patients with a unilateral bone deformation were acquired in a prospective study. The bones were segmented from CT and MRI, and cartilage only from MRI. The deformed bones were virtually reconstructed, by registering the joint ends to the healthy contralateral side. An optimal osteotomy plane was determined that minimized the distance between the resulting fragments. This process was performed in threefold: using the CT and MRI bone segmentations, and the MRI cartilage segmentations.
RESULTS
Comparison of bone segmentation from MRI and CT scan resulted in a 0.95 ± 0.02 Dice Similarity Coefficient and 0.42 ± 0.07 mm Mean Absolute Surface Distance. All realignment parameters showed excellent reliability across the different segmentations. However, the mean differences in translational realignment between CT and MRI bone segmentations (4.5 ± 2.1 mm) and between MRI bone and MRI bone and cartilage segmentations (2.8 ± 2.1 mm) were shown to be clinically and statistically significant. A significant positive correlation was found between the translational realignment and the relative amount of cartilage.
CONCLUSION
This study indicates that although bone realignment remained largely similar when using MRI with and without cartilage information compared to using CT, the small differences in segmentation could induce statistically and clinically significant differences in the osteotomy planning. We also showed that endochondral cartilage might be a non-negligible factor when planning osteotomies for young patients.
Topics: Young Adult; Adolescent; Humans; Forearm; Reproducibility of Results; Prospective Studies; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Osteotomy; Cartilage, Articular
PubMed: 37219804
DOI: 10.1007/s11548-023-02929-8 -
Journal of Oral and Maxillofacial... Nov 2021Three-dimensional (3D) assessment of orthognathic surgery is often time consuming, relies on manual re-identification of anatomical landmarks or is limited to...
PURPOSE
Three-dimensional (3D) assessment of orthognathic surgery is often time consuming, relies on manual re-identification of anatomical landmarks or is limited to non-segmental osteotomies. The purpose of the present study was to propose and validate an automated approach for 3D assessment of the accuracy and postoperative outcome of segmental bimaxillary surgery.
METHODS
A semi-automatic approach was developed and validated for virtual surgical analysis (VSA) of segmental bimaxillary surgery using a pair of pre- and postoperative (2 weeks) cone-beam computerized tomography (CBCT) scans. The output of the VSA, the accuracy of the surgical outcome, was calculated as 3D translational and rotational differences between the planned and postoperative movements of the individual bone segments. To evaluate the reliability of the proposed VSA, intra-class correlation coefficients (ICC) were calculated at a 95% confidence interval on measurements of 2 observers. The VSA was deemed reliable if the ICC was excellent (> 0.80) and the absolute difference of the repeated intra- and inter-observer translational and rotational measurements were significantly lower (p < 0.05) than a hypothesized clinical relevant threshold of 1 voxel (0.45 mm) and 1 degree, respectively.
RESULTS
A total of 10 subjects (6 male; 4 women; mean age 24.4 years) with skeletal class 2 and 3, who underwent segmental bimaxillary surgery, 3-piece Le Fort I, bilateral sagittal split osteotomy and genioplasty, were recruited. The intra- and inter-observer reliability was excellent, ICC range [0.96 - 1.00]. The range of the mean absolute difference of the repeated intra- and inter-observer translational and rotational measurements were [0.07 mm (0.05) - 0.20 mm (0.19)] and [0.11˚ (0.08) - 0.63˚ (0.42)], respectively. This was significantly lower than the hypothesized clinical relevant thresholds (P < .001).
CONCLUSION
The validation showed that the VSA has excellent reliability for quantitative assessment of the postoperative outcome and accuracy of segmental bimaxillary surgery.
Topics: Adult; Cone-Beam Computed Tomography; Female; Humans; Imaging, Three-Dimensional; Male; Orthognathic Surgery; Orthognathic Surgical Procedures; Osteotomy, Le Fort; Osteotomy, Sagittal Split Ramus; Reproducibility of Results; Young Adult
PubMed: 34245697
DOI: 10.1016/j.joms.2021.06.003 -
The Journal of Foot and Ankle Surgery :... 2022This study aimed to evaluate different fixation techniques and implants in oblique and biplanar chevron medial malleolar osteotomies using finite element analysis. Both...
This study aimed to evaluate different fixation techniques and implants in oblique and biplanar chevron medial malleolar osteotomies using finite element analysis. Both oblique and biplanar chevron osteotomy models were created, and each osteotomy was fixed with 2 different screws (3.5 mm cortical screw and 4.0 mm malleolar screw) in 2 different configurations; (1) 2 perpendicular screws, and (2) an additional third transverse screw. Nine simulation scenarios were set up, including 8 osteotomy fixations and the intact ankle. A bodyweight of 810.44 N vertical loading was applied to simulate a single leg stand on a fixed ankle. Sliding, separation, frictional stress, contact pressures between the fragments were analyzed. Maximum sliding (58.347µm) was seen in oblique osteotomy fixed with 2 malleolar screws, and the minimum sliding (17.272 µm) was seen in chevron osteotomy fixed with 3 cortical screws. The maximum separation was seen in chevron osteotomy fixed with 2 malleolar screws, and the minimum separation was seen in oblique osteotomy fixed with 3 cortical screws. Maximum contact pressure and the frictional stress at the osteotomy plane were obtained in chevron osteotomy fixed with 3 cortical screws. The closest value to normal tibiotalar contact pressures was obtained in chevron osteotomy fixed with 3 cortical screws. This study revealed that cortical screws provided better stability compared to malleolar screws in each tested osteotomy and fixation configuration. The insertion of the third transverse screw decreased both sliding and separation. Biplanar chevron osteotomy fixed with 3 cortical screws was the most stable model.
Topics: Biomechanical Phenomena; Bone Screws; Finite Element Analysis; Humans; Osteotomy; Tibia
PubMed: 34456133
DOI: 10.1053/j.jfas.2021.07.017 -
Arthroscopy : the Journal of... Jun 2022A medial opening wedge high tibial osteotomy is a cost-effective procedure for younger patients with symptomatic medial compartment knee arthritis. A high rate of...
A medial opening wedge high tibial osteotomy is a cost-effective procedure for younger patients with symptomatic medial compartment knee arthritis. A high rate of success can be expected, but excessive postoperative joint line obliquity is associated with inferior clinical outcomes. If preoperative planning predicts that the postoperative medial proximal tibial angle, the medial angle between the tibial anatomical axis and the joint line of the proximal tibia, will exceed 95°, a surgeon should consider performing a double-level osteotomy (combined proximal tibial and distal femoral osteotomies).
Topics: Arthritis; Humans; Knee Joint; Osteoarthritis, Knee; Osteotomy; Postoperative Period; Tibia
PubMed: 35660185
DOI: 10.1016/j.arthro.2021.12.025 -
Unfallchirurgie (Heidelberg, Germany) Jul 2022The treatment of tibial plateau fractures has experienced a number of very different conceptual developments in recent years, not only with respect to technical... (Review)
Review
BACKGROUND
The treatment of tibial plateau fractures has experienced a number of very different conceptual developments in recent years, not only with respect to technical innovations but also against the background of changing fracture patterns and the growing requirements of patients.
OBJECTIVE
What developments in recent years have had a significant impact on current treatment strategies for tibial plateau fractures?
METHODS
Narrative review of publications listed in PubMed on the topic of treatment of complex tibial plateau fractures.
RESULTS
While the two-dimensional classifications are becoming less important, computed tomography (CT)-based three-dimensional assessment of fracture progression and an access strategy based on it are coming to the fore. Direct dorsal approaches have been shown to be superior, particularly in the case of relevant posteromedial and/or posterolateral fracture involvement. The step-by-step approach extension via specific osteotomies of ligamentous attachments also enables a needs-dependent and fracture-dependent complete joint visualization and reduction control. In the treatment of geriatric tibial plateau fractures, primary treatment with endoprostheses is becoming increasingly more important to enable early mobilization under full load bearing with significantly shorter rehabilitation times.
CONCLUSION
Modern developments in the context of fracture treatment around the tibial plateau have led to a relevant reduction of infections and improved surgical outcomes; however, the high demands and the improved understanding of fractures still underline the great challenge in the treatment of complex fracture patterns.
Topics: Aged; Fracture Fixation, Internal; Humans; Osteotomy; Tibia; Tibial Fractures; Tomography, X-Ray Computed
PubMed: 35380266
DOI: 10.1007/s00113-022-01165-0 -
The Journal of Small Animal Practice May 2023To investigate the perioperative complications and outcomes of rabbits undergoing partial ear canal ablation and lateral bulla osteotomy for treatment of chronic otitis.
OBJECTIVE
To investigate the perioperative complications and outcomes of rabbits undergoing partial ear canal ablation and lateral bulla osteotomy for treatment of chronic otitis.
MATERIALS AND METHODS
Surgical logbooks were searched to identify rabbits that underwent partial ear canal ablation and lateral bulla osteotomy between December 2009 and September 2021. Data collected included signalment, history, clinical signs, historical and current medical management, physical examination findings, preoperative diagnostic imaging and aural bacterial culture results, surgical procedure information, duration of hospitalisation, complications and final outcome.
RESULTS
Twenty rabbits with chronic, medically unresponsive otitis underwent 27 partial ear canal ablation and lateral bulla osteotomies. Ten rabbits had pre-existing neurologic deficits and 17 had an ear base abscess at the time of surgery. A total of 13 (65%) rabbits developed at least one complication, either in the perioperative period or between discharge and recheck. Three of these rabbits (15%) underwent revision surgery for persistent or recurrent ear base abscess. Complete resolution of clinical signs ultimately occurred in 12 (60%) rabbits. Three (15%) rabbits showed improved but not completely resolved clinical signs (three facial asymmetry). Five (25%) rabbits died of causes potentially related to chronic otitis and/or partial ear canal ablation and lateral bulla osteotomy; two of these rabbits had undergone revision surgery.
CLINICAL SIGNIFICANCE
Although this study reports a high complication rate (65%), most complications resolved, with 15 (75%) rabbits having a good to excellent final outcome. Since the majority of rabbits in this study had chronic and severe ear disease, further studies are required to determine if surgical intervention earlier in the disease process could result in a lower complication rate.
Topics: Rabbits; Animals; Ear Canal; Otitis Media; Otitis Externa; Abscess; Blister; Osteotomy
PubMed: 36756788
DOI: 10.1111/jsap.13587 -
Archives of Orthopaedic and Trauma... May 2023Patellar malalignment has been considered one of the major pathomechanical causes of patellofemoral instability and pain. The results have been reported after femoral...
Combined distal femoral osteotomy and tibial tuberosity distalization is effective in patients presenting with patellar instability and patellofemoral pain due to patella alta and femoral malalignment.
INTRODUCTION
Patellar malalignment has been considered one of the major pathomechanical causes of patellofemoral instability and pain. The results have been reported after femoral varization/torsional osteotomy and tibial tuberosity distalization osteotomy (TTD-O). However, the combination of a femoral deformity (genu valgum/increased femur antetorsion) and patella alta remains underreported. Therefore, the aim of this study was to investigate the clinical outcomes of patients simultaneously treated by distal femoral osteotomy and TTD-O. The hypothesis was that restoration of patellofemoral (PF) alignment via the abovementioned osteotomies would achieve good patient-reported outcome measures.
MATERIALS AND METHODS
Between 2016 and 2019, a series of 25 knees in 20 patients were treated by a distal femoral osteotomy combined with a TTD-O aiming to correct patellofemoral malalignment consisting of genu valgum and/or increased femur antetorsion and patella alta. Six patients were lost to follow-up, and one patient refused to participate. Thus, 17 knees in 13 patients (male/female 1/12; age 27.4 ± 5.4 years) were included and comprised the study group for this investigation. Patients were evaluated after a mean of 3.1 ± 0.9 years postoperatively. The Kujala anterior knee pain scale and the PF-subscale of the Knee Osteoarthritis and Outcome score (KOOS-PF) were used to assess patients' reported outcome measures from pre- to postoperatively.
RESULTS
The mean amount of torsional correction, valgus correction, and tibial tuberosity distalization averaged 14° (10°-18°), 5.2° (3.8°-8°), and 9 mm (6°-15 mm), respectively. The Kujala score increased by an average of 24.18 points from a mean of 66.6 ± 18.3 points (34-93 points) preoperatively to 90.8 ± 14.2 points (44-100 points) postoperatively (95% CI - 33.0 to - 15.3; p < 0.0001). The KOOS-PF score increased by an average of 33.7 points from a mean of 49.5 ± 24.5 points (9.1-88.6 points) preoperatively to 83.2 ± 21.6 points (15.9 -100 points) postoperatively (95% CI - 47.5 to - 19.9; p < 0.0001).
CONCLUSION
The findings of this study indicate that the combination of a distal femoral osteotomy and a tibial tuberosity distalization osteotomy is effective in patients presenting with patellar instability and patellofemoral pain due to patella alta and femoral malalignment.
Topics: Humans; Male; Female; Young Adult; Adult; Patella; Joint Instability; Genu Valgum; Patellofemoral Pain Syndrome; Patellofemoral Joint; Retrospective Studies; Femur; Tibia; Osteotomy; Patellar Dislocation
PubMed: 35861870
DOI: 10.1007/s00402-022-04541-y -
Clinics in Sports Medicine Jul 2024Coronal and sagittal plane knee malalignments have been shown to increase the forces on anterior cruciate ligament (ACL) grafts after ACL reconstruction (ACLR). Studies... (Review)
Review
Coronal and sagittal plane knee malalignments have been shown to increase the forces on anterior cruciate ligament (ACL) grafts after ACL reconstruction (ACLR). Studies have shown the benefit of high tibial osteotomy to address coronal and sagittal imbalance in revision ACLR. The purpose of this article is to further describe the use of osteotomy by reviewing preoperative planning, indications, techniques, and outcomes of high tibial opening and closing wedge as well as anterior tibial closing wedge osteotomies in the setting of ACLR.
Topics: Humans; Anterior Cruciate Ligament Reconstruction; Osteotomy; Tibia; Anterior Cruciate Ligament Injuries
PubMed: 38811117
DOI: 10.1016/j.csm.2023.08.006