Corrective osteotomy
synonym
Corrective Osteotomy
definition
A corrective osteotomy is understood to be in the presence of Misalignments different joints, the loosening of one or more bone connections from each other, the correction of the deviating axes and the re-joining of the bone connections.
application areas
Repositioning osteotomies are performed whenever it becomes significant Axis shifts and Misalignments in various Joints of the skeleton and an orthopedic-technical correction in the form of splints or insoles was unsuccessful. The indication for a sometimes complex operation is only made if there are accompanying complaints of the patient, e.g. far-reaching bad posture or restrictions in walking, sitting and lying down. Furthermore, an indication for such an operation can be excessive suffering on the part of the patient.
There bone are rigid in a healthy state, misalignments are only caused by irregular wear in the adjacent joint. Knock knees e.g. only come about when the inside of the Knee joint gapes too far and there is increased pressure on the outside. The axis of the leg is therefore too far out.
Adjustment osteotomies are only performed if there are major changes in the joints and accompanying malpositions. In most cases, these misalignments have developed over the years and have increasingly led to the affected person being restricted in his everyday life and in his movements. Conversion osteotomies are most common on the hip, at the knee as well as the Toes carried out.
diagnosis
The indication for implementation is provided by the Orthopedist. By questioning, he first determines how long a specified misalignment has already existed and which non-operative measures have already been taken (wearing insoles, etc.). Lengths.
In order to get an objective impression of the bone condition, always X-rays of the corresponding joint and bones, mostly in two planes. With the help of these x-ray images, in which angles and axes are also drawn, the orthopedic surgeon can plan the operation in advance. After each indication, the patient is informed in detail and informed about which Side effects and Risks involves an adjustment osteotomy. Conversion osteotomies are usually performed in one operation. In the case of complex deformities, however, it may be necessary to carry out a so-called correction after the first correction of the deformity External fixator must be attached. These are metal rods that are attached outside the body and are connected to the bone or joint through small holes by cross bracing. After a few weeks, a second operation is carried out in which the frame and the cross braces are removed again.
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Aftercare
Shortly after the surgery definitely should be the affected joint spared and for now immobilized until the newly joined bone ends are in a solid state again. This period of rest can vary depending on the joint and the operation performed 6- 12 weeks last. It is necessary on a regular basis X-rays of the operated joint in order to monitor the healing process and, if necessary, to be able to intervene again.
Chances of success
The chances of success vary greatly depending on the affected joint and the operation performed. The at Knee or hip TEPs Correction of the axes and the lengths carried out at the same time is mostly without any complications and does not need to be further corrected. It should be noted, however, that one-sided TEP operations often lead to a Improper loading of the other leg, which can also lead to misalignments. For this reason, years after a hip or knee TEP is implanted, the opposite side is usually operated on. The chances of success with a Hallux valgus osteotomy is less successful. It often takes months before patients can walk properly again after an operation. If the incorrect load is still present, the hallux valgus may develop again. In addition, bones are removed after an osteotomy of the big toe, resulting in a Toe shortening and may lead to instability in walking and standing. Ultimately, the postoperative career is considered special painful described by the patient.
Repositioning osteotomy of the hip
The correction operation in the hip is performed relatively rarely alone. This operation is only performed if the thigh is very misaligned. However, conversion osteotomies are much more common implantation one Total hip replacement carried out. If there is one break Femoral neck after a fall or joint destruction Hip arthrosis the indication of a hip replacement implantation can be made. During this operation, axis corrections and corrections to the leg lengths are made in almost all cases after the prosthesis material has been inserted. There are two main reasons for this: on the one hand, you can Leg length differenceswhich may have led to poor posture in the patient for years can be corrected relatively easily (the hip replacement is only slightly corrected or realigned so that the leg axis runs correctly again), on the other hand, after a hip prosthesis has been inserted, the Leg axis and leg length are realigned. With this osteosynthesis procedure, the axes can be shifted up to several cm to the left or right and the leg lengths can be corrected accordingly.
Repositioning osteotomy of the knee
Also at knee it is so that an operative osteotomy only has to be performed in the case of severe malpositions. Mostly, however, after an implantation Total knee replacementin which the leg axes and leg length can (must) be corrected. It should not be forgotten that in the case of severe misalignments, one inevitably arthrosis is present in the corresponding joint, so that in severe cases it is almost always necessary to insert an endoprosthesis.
Further indications:
In addition to the misalignments of the joints that have developed over the years, congenital misalignments of joints are also an indication for a conversion osteotomy. A somewhat rarer indication is the conversion osteotomy after accidents. However, slight axis corrections after severe bone fractures, for example, are common.
Corrective osteotomy of the lower leg
Adjustment osteotomies in the area of the lower leg are always considered as an operative therapy method if a correction of leg deformities (If one/ Knock knees due to unevenly healed bone fractures or congenital malpositions).
Axis misalignments that exist over a longer period of time can lead to incorrect loads in the knee joint, which in the course of the Knee cartilage and thereby a painful one Osteoarthritis of the knee being able to lead.
In order to avoid or delay an artificial knee joint replacement in the advanced stage of osteoarthritis, a conversion osteotomy can be performed Correction of the knock knees or bow legs as an option.
During the operation, which takes place under general anesthesia, the Shin bone Saw through near the knee joint across to the opposite bone edge and unfolded in a further step until the desired or calculated axis position is reached. This position is then fixed with screws and plates and, if necessary, the saw gap is filled with the body's own bone material (mostly from the iliac crest) filled up.
After the operation, the operated leg may only be partially loaded for about 6 weeks, the metal plate is removed after about a year.
Change osteotomy of the toes
The correction of the axes of the toes is made frequently carried out. The reasons are mostly so-called Hammer toe (Hallux valgus), in which there is a c-shaped deformation of the big toe. The reasons are often shoes that were worn too small in childhood. With advanced hallux valgus, patients usually complain of one instability in the entire foot when running, further over Pain when moving. These are caused by the fact that a misalignment in a joint always comes with it arthritic wear and tear are connected.
Cosmetic reasons also often contribute to the decision to have an osteotomy of the foot toe. During the operation that took place in general anesthetic is carried out, the two bones of the toe are separated at the point of the connecting joint. In the course of time and the progression of the deformity, the ends of the bones have adapted to the deformity and the end edges of the bones have been "filed" crookedly. These crooked spots are straightened with a saw so that the two bones are straight to each other again. Then the toe is brought back into a straight position as a whole. Wires are introduced to ensure that the toe is still unstable. Then the wounds are closed. The wires are removed after a few weeks, when the new bone ends have reconnected to the joint.
Change osteotomy of the jaw
The conversion osteotomy of the jaw is understood to mean the operative change in the positional relationship of the lower and upper jaw, whereby either only one part of the jaw (either lower or upper jaw) or the position of both parts of the jaw is changed.
The conversion osteotomy can always be considered as a surgical-therapeutic procedure if the affected person has a pronounced Jaw misalignment present (dysgnatia; jaws and teeth deviate from the norm: e.g. open bite, Overbite etc.) that cannot be corrected by conventional orthodontic measures.
The surgical procedure usually goes one orthodontic preparatory phase 6-18 months in advance as well as the removal of any wisdom teeth. The Corrective osteotomy itself is in general anesthetic carried out and is accompanied by a stay of several days at the station.
In order to change the position of the lower and / or upper jaw, they must first be detached from the facial skull during the operation in order to then be fixed again in the desired position with screws and plates.
After the operation, a further orthodontic treatment phase is usually carried out, which is used to fine-tune the tooth positions. In order to ultimately achieve a permanently secured tooth and jaw position, so-called retainers (Wires) glued to the back of the upper and lower incisors.
Once the bone has healed, the screws and plates are removed in another surgical procedure.
Summary
Reversal osteotomies are Correction operations of joints in the skeleton, which can be necessary if technical orthopedic measures such as insoles do not bring any improvement or if the misalignments are so severe that they close Pain and to the strong impairment of the patient. The most common repositioning osteotomies of the big toe (Hallux valgus) and as part of a Hip or knee TEP implantation.
As a rule, conversion osteotomies are carried out in such a way that the misaligned bones are detached from one another at one joint. Inclined edges caused by the misalignment are straightened with a saw and the new hinge edges are put together again. After that, the joint must for 6-12 weeks be immobilized. The load build-up should be carried out slowly. The indication of an osteotomy is made by means of Axis and angle measurement placed on the patient.
Furthermore, appropriate X-rays in which the axes to be corrected are drawn in again. In most cases, corrective osteotomies are performed in one-off procedures. However, severe malpositions often require two interventions. The first procedure is a so-called Fixator attached externally to the outside of the leg, which should lead to increased stability of the newly created axis. These metal rods are then left for a few weeks and then removed again in a second operation. After a conversion osteotomy, the course and the need for corrective surgery should be checked by means of a control X-ray. The Chances of success an adjustment osteotomy vary greatly. A hallux valgus osteotomy is considered to be more strenuous, while osteotomies after TEP implantation are less problematic.
