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Neurosurgery Jan 2014Global sagittal malalignment is significantly correlated with health-related quality-of-life scores in the setting of spinal deformity. In order to address rigid...
BACKGROUND
Global sagittal malalignment is significantly correlated with health-related quality-of-life scores in the setting of spinal deformity. In order to address rigid deformity patterns, the use of spinal osteotomies has seen a substantial increase. Unfortunately, variations of established techniques and hybrid combinations of osteotomies have made comparisons of outcomes difficult.
OBJECTIVE
To propose a classification system of anatomically-based spinal osteotomies and provide a common language among spine specialists.
METHODS
The proposed classification system is based on 6 anatomic grades of resection (1 through 6) corresponding to the extent of bone resection and increasing degree of destabilizing potential. In addition, a surgical approach modifier is added (posterior approach or combined anterior and posterior approaches). Reliability of the classification system was evaluated by an analysis of 16 clinical cases, rated 2 times by 8 different readers, and calculation of Fleiss kappa coefficients.
RESULTS
Intraobserver reliability was classified as "almost perfect"; Fleiss kappa coefficient averaged 0.96 (range, 0.92-1.0) for resection type and 0.90 (0.71-1.0) for the approach modifier. Results from the interobserver reliability for the classification were 0.96 for resection type and 0.88 for the approach modifier.
CONCLUSION
This proposed anatomically based classification system provides a consistent description of the various osteotomies performed in spinal deformity correction surgery. The reliability study confirmed that the classification is simple and consistent. Further development of its use will provide a common frame for osteotomy assessment and permit comparative analysis of different treatments.
Topics: Humans; Osteotomy; Reproducibility of Results; Scoliosis
PubMed: 24356197
DOI: 10.1227/NEU.0000000000000182o -
Foot & Ankle Specialist Jun 2011Introduction. The Weil osteotomy is commonly used for multiple forefoot pathologies yielding metatarsalgia. Despite its common use, the Weil osteotomy is associated with... (Review)
Review
Introduction. The Weil osteotomy is commonly used for multiple forefoot pathologies yielding metatarsalgia. Despite its common use, the Weil osteotomy is associated with a high complication rate. Methods. A literature review was undertaken with predetermined criteria. To maximize the articles for review, prospective and retrospective studies were considered as well as multiple indications. Seventeen articles qualified for analysis, and study format, patient demographics, surgical indication, and complication rates were documented. The data obtained were totaled and evaluated for trends. Results. Details of 1131 Weil osteotomies are reported. The most commonly reported complication of the Weil osteotomy was floating toe, reported in 233 cases, with an overall occurrence of 36%. Recurrence was reported in 15% of the cases. Transfer metatarsalgia was reported in 7% of the cases, whereas delayed union, non-union, and malunion were collectively reported in 3% of the cases. Discussion. There is no consensus regarding utilization of the Weil osteotomy with prophylactic surgery, plantar plate repair, and adjunctive interphalangeal arthrodesis. These variables may alter complication rates and provide new avenues for research.
Topics: Humans; Metatarsal Bones; Metatarsalgia; Osteotomy
PubMed: 21490179
DOI: 10.1177/1938640011402822 -
Acta Orthopaedica Belgica 1990A new technique to plan and perform a reorientation pelvic osteotomy around the hip joint in adolescents and adults is described. Planning is based on 3-dimensional... (Review)
Review
A new technique to plan and perform a reorientation pelvic osteotomy around the hip joint in adolescents and adults is described. Planning is based on 3-dimensional reconstruction of the hip joint. The operation is simulated by computer before surgery to find the correction angles which optimize alignment both quantitatively (amount of femoral head covered) as well as qualitatively (joint congruency). These angles are then utilized at the time of surgery. A Smith-Petersen approach is always used to perform the osteotomy. The pelvic ring is not displaced, but nevertheless the acetabular fragment can be tilted without limitation around all 3 axes. Furthermore, linear displacement permits medialization of a lateralized hip joint. Stability is obtained by simple screw fixation. The posterior column remains mechanically intact, and thus no cast is required. Since 1984, about 200 peri-acetabular osteotomies have been performed. The success of correction was evaluated on plain radiographs using A P and "false profile" views as well as by CT. Conventional radiographs showed fully normalized VCE (Wiberg) and VCA (de Sèze and Lequesne) angles and well-centered joints on the CT-based reconstructions. Four types of complications occurred: there were 2 cases with intra articular extension of the osteotomy; 1 transient femoral neuropraxia; 2 non-unions and 4 cases with ectopic ossifications which limited motion of the joint. The latter problem appear to have been eliminated by the administration of prophylactic indomethacin. Symptomatic fixation screws had to be removed after union in 13 cases.
Topics: Acetabulum; Adolescent; Adult; Computer Simulation; Female; Hip Dislocation; Hip Joint; Humans; Male; Middle Aged; Models, Anatomic; Osteotomy; Postoperative Complications
PubMed: 2200234
DOI: No ID Found -
Der Orthopade May 2017Distal osteotomies, like the Chevron osteotomy, is indicated for mild to moderate hallux valgus deformities. Splayfoot, painful pseudoexostosis, and transfer... (Review)
Review
Distal osteotomies, like the Chevron osteotomy, is indicated for mild to moderate hallux valgus deformities. Splayfoot, painful pseudoexostosis, and transfer metatasalgia are observed in the clinical examination. Radiographic examination should be done with weight bearing in two planes. Preoperatively the intermetatarsal (IM), hallux valgus, and distal metatarsal articular (DMAA) angles should be measured. The operative technique is based on soft tissue and bony correction. Modifications of the osteotomy allow a shortening, lengthening, or neutral correction of the first metatarsal. With a modified Chevron osteotomy, an increased DMAA can be also corrected.
Topics: Evidence-Based Medicine; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Plastic Surgery Procedures; Treatment Outcome
PubMed: 28405710
DOI: 10.1007/s00132-017-3422-6 -
Foot and Ankle Clinics Mar 2005The purpose of this article is to review our experience with malunion and nonunion of proximal and distal first metatarsal osteotomies and to outline the treatment... (Review)
Review
The purpose of this article is to review our experience with malunion and nonunion of proximal and distal first metatarsal osteotomies and to outline the treatment options when such complications occur.
Topics: Biomechanical Phenomena; Bone Malalignment; Humans; Metatarsal Bones; Osteotomy; Treatment Failure
PubMed: 15831257
DOI: 10.1016/j.fcl.2004.10.001 -
Archives of Orthopaedic and Trauma... May 2004Proximal tibial osteotomy produces satisfactory early results, but these good results deteriorate with time. A meta-analysis, a set of statistical procedures designed to... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Proximal tibial osteotomy produces satisfactory early results, but these good results deteriorate with time. A meta-analysis, a set of statistical procedures designed to accumulate experimental and correlational results across independent studies, was undertaken to determine the final outcome of high tibial osteotomy of the knee.
MATERIALS AND METHODS
Following a comprehensive literature search from 1970 through 1998, the data of 19 relevant published studies were analysed in three separate arms.
RESULTS
High tibial osteotomy had an averaged probability of a good or excellent result in 75.3% of the patients after 60 months and 60.3% after 100 months. The overall failure rate, including re-osteotomies, arthroplasties, meniscectomies, ligament reconstructions, infections and non-unions, was 24.6% at 10 years. The probability for total knee arthroplasty was 0.034 before 24 months, 0.078 between 24 and 47 months, and 0.114 between 48 and 71 months.
CONCLUSIONS
The meta-analysis showed that high tibial osteotomy has an averaged probability of a good result in 60.3% of patients even after 100 months. Unchanged and mild pain was considered an unsatisfactory result. Knowing the natural cause of the disease, it is likely that most of these patients also gained from their operation to some extent, although the outcome was not as good as expected. However, we believe that there is a role for closed tibial osteotomy, as an alternative to total knee arthroplasty, only in carefully selected young patients.
Topics: Humans; Osteoarthritis, Knee; Osteotomy; Tibia; Treatment Outcome
PubMed: 12827394
DOI: 10.1007/s00402-003-0545-5 -
Foot and Ankle Clinics Sep 2001Distal osteotomies are the original osteotomies performed in the first metatarsal for bunion surgery. Many of these can be fashioned to improve an abnormal DMAA.... (Review)
Review
Distal osteotomies are the original osteotomies performed in the first metatarsal for bunion surgery. Many of these can be fashioned to improve an abnormal DMAA. Correction of an abnormally wide first-second IM angle is a goal of the newer procedures. Lateral transposition at the osteotomy site first performed by Mitchell helps accomplish this goal. The chevron modification improves stability and offers sufficient correction for mild-to-moderate deformities. Fixation is recommended after metatarsal osteotomy. The distal chevron procedure has been associated with lower degrees of correction, but the risk of transfer metatarsalgia is minimized. Shortening is less likely compared with some distal osteotomies but can occur. Advanced age is not a contraindication for distal metatarsal osteotomy. Avascular necrosis is highly unusual after this procedure.
Topics: Age Factors; Hallux Valgus; History, 20th Century; Humans; Internal Fixators; Metatarsal Bones; Osteotomy; Tarsal Joints
PubMed: 11692491
DOI: 10.1016/s1083-7515(03)00106-2 -
The British Journal of Oral &... Jun 2022The aim of this systematic review is to evaluate the accuracy of waferless osteotomy procedures in orthognathic surgery with a secondary aim to determine the... (Review)
Review
The aim of this systematic review is to evaluate the accuracy of waferless osteotomy procedures in orthognathic surgery with a secondary aim to determine the cost-effectiveness of the procedure. A literature search was conducted on the databases PubMed and Scopus, with PRISMA guidelines followed. An initial yield of 4149 articles were identified, ten of which met the desired inclusion criteria. The total sample of patients undergoing waferless osteotomies included in this review was 142 patients. Nine of the studies used surgical cutting guides along with customised surgical plates to eliminate the surgical wafer and one study used pre-bent locking plates instead of customised plates. The eligible articles determined their surgical accuracy by comparing the positions of bony or dental landmarks on the pre-operative and post-operative images. The articles all reported acceptable accuracy within previously established clinical parameters. The majority of authors concluded that it is an accurate surgical approach and can be cost effective which is often a barrier to novel techniques however there were studies that contrasted the view of the cost efficacy. Due to the lack of published randomised controlled trials, current evidence is not strong enough to recommend the use of surgical cutting guides and customised/pre-bent plates for orthognathic surgery.
Topics: Cost-Benefit Analysis; Humans; Maxilla; Orthognathic Surgical Procedures; Osteotomy; Surgery, Computer-Assisted
PubMed: 35305840
DOI: 10.1016/j.bjoms.2021.05.005 -
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 -
American Journal of Orthopedics (Belle... Feb 1995Olecranon osteotomy for visualization of the distal humerus has a high complication rate. Two basic osteotomies, intra-articular and extra-articular, are in current use.... (Review)
Review
Olecranon osteotomy for visualization of the distal humerus has a high complication rate. Two basic osteotomies, intra-articular and extra-articular, are in current use. Each is examined using the engineering technique of free-body analysis. The osteotomy fragment mechanics are found to influence both the nature of the fixation and the clinical outcome. In addition to the advantages gained from not disrupting the joint surface, oblique extra-articular osteotomy may have mechanical advantages over transverse intra-articular osteotomy because of decreased osteotomy surface distraction force with triceps contraction.
Topics: Biomechanical Phenomena; Elbow Joint; Humans; Humeral Fractures; Osteotomy; Ulna
PubMed: 7613971
DOI: No ID Found