Osteotomy is what?

Osteotomy is a surgical intervention whose purpose is to restore lost musculoskeletal functions through artificial bone dissection. In most cases, it is used to eliminate deformity of the limbs, which allows to return the patient's ability to self-service and movement.

General concepts

Operation osteotomy is carried out by highly skilled surgeons-traumatologists. At first glance, it seems that the intervention is complex and requires a lot of time to restore the patient, but compliance with the recommendations of doctors will quickly raise the patient to his feet.

Osteotomy is an operation that is carried out with the help of special tools - osteotomes, Jigley saws, electric saws and ultrasonic devices. They help to make holes in the site of intervention and dissect bone tissue. After collecting fragments fragments of bones are fixed with screws, knitting needles, plates. Unlike random fractures, the plaster bandage is rarely applied to avoid possible development of contractures in the joints.

Classification

Depending on the nature of operational access, the following types of osteotomy are distinguished:

1. Open - requires wide access to bone tissue. After the cut of the skin, subcutaneous tissue and muscular apparatus, the periosteum is separated by the rasper, then the bone is dissected. The fragments are fixed in the physiological position, on top - plaster bandage.
2. Closed - is carried out through access in a few centimeters. Muscles are not cut, but stratified to get to the bone tissue. Using a chisel, the periosteum is separated and a bone is cut through the handle by several hammer strokes. Vessels and nerves are removed and fixed with special tools to avoid their damage. More commonly used for transverse osteotomies.

The following interventions are distinguished by the form of dissection:

• Transverse;
• Staircase;
• Oblique;
• Zigzagging;
• Hinged (spherical, arc-shaped, wedge-shaped, angular).

Depending on the goal, surgical intervention is of the following types:

• Corrective osteotomy;
• Degeneration;
• Aimed at changing the length of the limb;
• Is aimed at improving the supporting function.

Indications for intervention

Osteotomy is an orthopedic operation that is performed in the following cases that do not respond to conservative therapy:

• Congenital or acquired anomalies and deformations of bone tissue, mostly long tubular bones (thigh, shoulder, shin);
• Ankylosis - the inability of joint functioning due to the presence of joints of connective tissue, cartilaginous or bony nature of articular surfaces;
• Congenital hip dysplasia (dislocation);
• Fractures that mishandled;
• osteomyelitis;
• The presence of neoplasms or metastases;
• The effects of rickets in history;
• Carrying out arthroplasty;
• Other congenital anomalies of the musculoskeletal system.

The operation is also used in the cosmetic field: osteotomy of the nose, correction of the oval of the face, impaired functions of the jaws.

Contraindications

There are a number of factors in the presence of which surgical intervention is postponed:

• Infections of an infectious nature at the time when bone osteotomy is required or two weeks before surgery;
• Diseases of the respiratory and cardiovascular system in the stage of decompensation;
• diabetes;
• Period of bearing of the child;
• Renal or hepatic insufficiency;
• Presence of precipitation of purulent or other character in a place where it is necessary to conduct operative access.

Advantages and disadvantages

Positive moments of intervention are easing of the pain syndrome (if any) and restoration of motor functions. For example, osteotomy of the knee joint will eliminate pain during movement, resume flexion and extensor function, remove joints of articular surfaces. The disease stops its progression.

The disadvantage is the possibility of visual asymmetry of the limbs or joints. Moreover, if a patient needs endoprosthetics with a joint replacement, then it will be more difficult to carry him after an osteotomy.

Possible complications

Osteotomy is an operation that has been improved over many years to reduce the risk of postoperative complications. However, any interference of extraneous factors in the human body is a source of increased danger, because in addition to the qualification of the operating specialist, it is also about the individual characteristics of the patient's body.

Complications of any kind of osteotomy can be:

• Infection of a postoperative wound - requires the appointment of shock doses of antibiotic therapy;
• Displacement of fragments and fragments of bone tissue - reposition is performed with further fixation;
• Slow fusion of bone - multivitamin complexes with the necessary trace elements (calcium, phosphorus, magnesium, zinc) are prescribed;
• Formation of a false joint , additional intervention is required;
• Parestesia - a violation of the sensitivity of the skin at the site of surgery due to the intersection of nerve branches (does not require additional treatment, is restored independently);
• Rejection of implants - endoprosthetics are necessary.

Corrective osteotomy

Such a procedure is used for improperly fractured fracture, birth defects of bone tissue, development of ankylosis or false joints, deformation of the foot bones with impaired motor function, to eliminate visual cosmetic defects.

Prior to the intervention, an X-ray examination is performed to determine the location of the bone, the location of the future dissection, the general condition of the bone tissue. If necessary, conduct a computer or magnetic resonance imaging. Other examinations are appointed by a traumatologist individually.

The operation is performed in specialized hospital settings. The duration of the intervention is about 3-4 hours, which depends on the volume of necessary procedures. After the bone is cut, the fragments are fixed with the Ilizarov apparatus (the operation is performed on the limbs) or with special metal devices that are injected directly into the bone (osteotomy of the foot).

Ilizarov's apparatus is a special structure used in the field of traumatology and orthopedics for fixing, compressing or stretching fragments of bone tissue in the necessary position for a long period of time.

After the operation, a control X-ray is taken to determine the correctness of the fixation.

Complications of corrective osteotomy

Possible complications after correction of pathological conditions include:

• Strong pain syndrome, not docked by usual analgesics;
• Breakdown of external parts of the device or metal structures;
• Development of bleeding;
• Formation of a hematoma;
• Displacement of bone fragments relative to each other in any of the planes;
• Other complications of a general nature.

Osteotomy in the field of dentistry and maxillofacial surgery

In the dental area, an osteotomy of the jaw is performed, which can act as an independent operation or as a stage of surgical intervention. Used for bias or fracture, to correct bite abnormality. Incisions are made along the jaw behind the molars.

After fixing the jaw in the physiological position, a pressure bandage is applied, fixing the area of the cheeks and chin. Immediately appointed antibiotic therapy in order to avoid the development of suppuration and the formation of osteomyelitis. Between the teeth, several rubber bands are applied, the location of which is observed daily by a specialist. The stitches are removed after 2 weeks, and the screws fixing the jaws, in a month, to complete the stage of treatment with the subsequent orthodontic therapy.

In the field of maxillofacial surgery, the osteotomy of the nose is used, which is part of rhinoplasty. Indications for the conduct are:

• Significant curvature of the back of the nose;
• Large size of bones;
• The need to bias the bones in relation to the nasal septum.

When performing osteotomy of the nose on the surgeon, the aesthetic tasks lie: closure of the arch of the nose, removal of the hump and straightening of the curvature of the back, narrowing of the side walls. The specialist should take into account that the dissection of bone tissue can affect the patency of the upper respiratory tract, therefore during the operation the anatomical and physiological features of the particular patient are taken into account.

Types of osteotomy of the nose:

• Lateral (edge), conducted perforating or linear method;
• Medial (center);
• Upper;
• Intermediate.

The type of intervention used is selected individually, taking into account the patient's problem, the purpose of the operation, the condition of the bone tissue, the necessary amount of surgical treatment.

Any osteotomy should be performed after raising the level of immunity. This will serve as a preventive measure for the development of complications and create conditions for a good and proper fusion of bone tissue.