Osteotomy - What Is It?

Osteotomy is a surgical procedure that involves cutting and repositioning bones to correct misalignment and restore normal anatomical alignment. It is commonly performed in orthopedic surgery to treat conditions such as deformities, malunions, nonunions, and osteoarthritis. This article will explore the various aspects of osteotomy, including its indications, types, surgical techniques, and postoperative considerations.

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Indications for Osteotomy

Deformities: Osteotomy is frequently used to correct bone deformities resulting from birth defects, traumatic injuries, or genetic conditions.

Malunions: When a bone heals in an incorrect position following a fracture, osteotomy can be employed to realign the bone.

Nonunions: In cases where a fracture fails to heal properly, osteotomy can stimulate bone regeneration and promote union.

Osteoarthritis: Osteotomy can alleviate pain and improve joint function in patients with early-stage osteoarthritis by redistributing forces within the joint.

Types of Osteotomy

Closing Wedge Osteotomy: In this technique, a triangular wedge-shaped piece of bone is removed from one side of the bone, allowing the remaining bone to be realigned. The bone is then fixed with plates, screws, or other fixation devices.

Opening Wedge Osteotomy: This method involves creating a gap or space in the bone, which is then filled with bone graft or other biomaterials to realign the bone.

Dome Osteotomy: This type of osteotomy is commonly used in pediatric orthopedics to correct angular deformities in growing bones. It involves cutting a semicircular dome-shaped section of bone and repositioning it to achieve alignment.

High Tibial Osteotomy: It is performed in the knee joint to shift weight-bearing forces away from the damaged area. The upper part of the tibia is cut and realigned to relieve pressure on the affected compartment.

Surgical Techniques

Preoperative Planning: Detailed imaging studies, such as X-rays, CT scans, or MRI, are essential to assess the degree of misalignment and plan the osteotomy procedure accurately.

Anesthesia: Osteotomy can be performed under general anesthesia or regional anesthesia, depending on the patient's condition and the surgical approach.

Incision and Bone Cutting: A carefully planned incision is made over the surgical site to access the bone. Specialized instruments, such as saws or osteotomes, are used to cut the bone precisely according to the predetermined plan.

Realignment and Fixation: Once the bone is cut, it is carefully repositioned into the correct alignment. Fixation devices, such as plates, screws, or rods, are employed to stabilize the bone during the healing process.

Closure: After ensuring the bone is properly aligned, the incision is closed with sutures or staples. 

Postoperative Considerations

Rehabilitation: Physical therapy plays a crucial role in the postoperative phase of osteotomy. It helps restore joint mobility, strengthen muscles, and promote functional recovery.

Pain Management: Adequate pain control is provided through medications, physical modalities, and other interventions to ensure patient comfort during the healing process.

Weight-Bearing and Activity Restrictions: Depending on the type of osteotomy and the bone's healing progress, weight-bearing and activity restrictions may be imposed to prevent complications and promote optimal bone healing.

Follow-up and Monitoring: Regular follow-up appointments are scheduled to monitor the progress of healing and address any concerns or complications that may arise.

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