Corrective osteotomy of the femur during the operation. Corrective osteotomy of the knee joint: indications, types of surgery and rehabilitation. Complications of corrective osteotomy

Corrective osteotomy of the foot is a type of surgical intervention performed on deformed limbs. The essence of the operation is an artificial fracture of the bones to correct the defect.

Every third inhabitant of the planet suffers from articular syndrome. Rheumatoid arthritis, rheumatism, systemic lupus erythematosus, fractures, birth defects cause pathological changes in the joints. The problem is solved conservatively or surgically. Therapeutic tactics depend on the severity of the pathology, the duration of the process, the data of laboratory, instrumental research methods.

It is carried out on the tibia, ankle, knee, hip, shoulder joints. Quality operations stop the disease. The patient returns to normal life thanks to modern methods of treatment.

Osteotomy is an alternative to arthroplasty. It is carried out in adults and children.

The main indications for the technique:

The child suffers from congenital anomalies of the skeleton.
Incorrect union of the fracture, the formation of a false joint.
Deforming changes in the feet occur as a result of a severe disease of the bone tissue.
Ankylosis is manifested by a complete loss of joint movement. Surgical intervention helps restore the function of the damaged limb.
It is carried out with a hammer-shaped deformity of the fingers.
Severe forms of clubfoot. Poorly amenable to conservative treatment.
Indicated for flat feet.
With valgus deformity of the first finger, surgical intervention is resorted to.

Types and forms of the procedure

Osteotomy corrects deformity of the foot in various areas. The method of the procedure is determined by the severity of the condition, the pathological area, indications and contraindications for the technique.

There are the following types:

Z-shaped or scarf-osteotomy is performed in patients with hallux valgus. The deformity is manifested by an inward curvature of the limb. The disease affects mainly the distal parts of the legs. Pathology occurs in the area of the thumbs. Physiotherapy, massage and scarf osteotomy allow you to get rid of foot valgus: restore the normal structure and function of the feet.

The technique has a number of advantages:

corrects complex changes in the anterior part of the foot;
allows for lateral displacement of bone fragments;
well tolerated by patients;
rarely accompanied by complications;
the rehabilitation period is short (1-1.5 months);
a scarf osteotomy can make the metatarsus shorter/longer if needed;
the technique allows to reduce the load on the first phalanx. The surgeons move the fragments down. Does not affect limb function.

With valgus of the feet, a bump appears on the thumb. Provides discomfort and pain. Scarf osteotomy allows you to remove the growth. The doctor fixes the fragments with the help of special screws.

A wedge osteotomy is performed on the first toe. The main indications are the short first metatarsal bone, hallux valgus. The main stages of surgical intervention include:

the surgeon makes an incision from the medial side of the first finger to the lateral;
further shifts the phalanx inward;
rotates the finger to a physiological position.

Osteotomy of the metatarsal bone is a simultaneous operation. It is used in combination with other surgical techniques to correct foot defects.

Angular allows you to give the correct position due to the bilateral excision of tissues. During the procedure, the surgeon cuts tissue at an angle from both sides. Bones become in a physiological position.

The linear form of the disease is divided into oblique and transverse. The essence of the operation is to align with a transplant.

Chevron osteotomy of the 1st metatarsal bone of the foot is used to treat valgus deformity of the first toe. The angle between the first and second phalanx is corrected.

The chevron shape has positive aspects:

after the procedure, a long-term therapeutic effect is maintained;
simplicity and safety of implementation;
allows you to restore the lost functions of the limb in full.

The course of the operation includes the following steps:

The surgeon makes a Y-shaped incision in the joint capsule.
It releases the head of the metatarsus from the tendons. Carries out a V-shaped cut to fully release the head.
Then the doctor brings the metatarsal head out and fixes it with a screw. The rest of the bone is excised.
Restores the integrity of the joint capsule and sutures the wound.
The sutures are removed 5-7 days after the operation.

There are other ways to treat the foot (McBride, Sheda, Silver surgery, laser correction). The type of surgical intervention depends on the indications and localization of the pathology.

A qualified specialist will carry out the operation with high quality. There are two types of intervention:

Closed - access is made through a small incision in the skin. The surgeon works blindly with a chisel. Requires high qualification, experience of the doctor. Wrong actions can result in damage to blood vessels and nerves.
The open method allows you to fully visualize the damaged area through a large incision.

How is a corrective osteotomy performed?

Manipulation of the forefoot is carried out in a planned manner. Before the operation, a complete examination package is prescribed:

A general analysis of blood and urine allows you to assess the state of the hematopoietic and renal systems. Intervention can be carried out in the absence of pathological changes in the analyzes.
Blood sugar is tested to rule out diabetes. With high glucose levels, the procedure cannot be performed.
A biochemical blood test allows you to evaluate the functions of the kidneys and liver, a coagulogram - blood clotting.
Fluorography of the lungs, ECG are carried out without fail.
To visualize the pathology, assess the degree of changes, the patient is sent for x-rays, computed tomography.

Corrective osteotomy on the forefoot is performed in several stages:

The patient is given general/spinal anesthesia.
The surgeon cuts the lateral surface of the foot.
Performs bone spraying using one of the methods described above.
Sets the joint of the first metatarsal bone in the correct position.
Removes a bump.
Fixes the first phalanx with screws or knitting needles.
The surgeon restores the anatomical position of the ligaments and tendons.
Next, sutures are applied to the skin.

After the operation, the patient is in the hospital for 3 days. Doctors monitor the patient's condition: temperature, blood pressure, pulse, respiratory rate, pulse oximetry. It is forbidden to load a sore leg. Wear hard-soled shoes for several months. Elastic bandaging of limbs is prescribed to prevent complications.

Make a control x-ray. It allows you to determine the degree of fusion, the overall dynamics. If there are no complications, doctors are allowed to give the leg a load. Over time, the patient can walk long distances, run, play sports.

Contraindications for surgery

Drug treatment of various deformities of the lower extremities is carried out for several months, years. Conservative therapy includes taking painkillers, vitamins, anti-inflammatory drugs. The patient goes to physiotherapy, massage, gymnastics. Methods are supplemented by wearing orthopedic devices: plaster casts, special splints, insoles, bandages.

Corrective osteotomy saves time and money. It takes several months after the operation, the patient begins to live fully.

Surgical treatment has a number of contraindications for performance:

Acute period, severe course of rheumatoid arthritis.
Active or past infectious diseases (syphilis, bone tuberculosis), their complications.
Cardiovascular insufficiency stage 3.
Oncological pathology.
Respiratory failure of the last stage.
Confirmed osteoporosis.
Obesity is a relative contraindication. The operation is performed with the permission of the attending physician.
Degenerative-dystrophic arthrosis, which is localized in the lateral parts of the joints.
III stage of patellofemoral arthrosis.

Corrective osteotomy of the foot refers to surgical intervention on the lower extremities. It is carried out in order to restore the physiological functions of the joints.

Corrective osteotomy is a high-tech operation that is used to correct deformities of the lower extremities. The technique gives especially good results with deforming arthrosis of the knee joint. Moreover, knee osteotomy is an effective alternative to arthroplasty! This surgery is well tolerated by patients, so the installation of an artificial joint can be delayed for many years. Ideal for people who are accustomed to an active lifestyle!

How is a corrective knee osteotomy performed?

The operation involves an artificial "fracture" of the lower leg (as shown in the figure) and the installation of a special plate. This allows you to change the axis of the leg and accordingly relieve pressure on the damaged part of the cartilage.

An x-ray examination is mandatory before the operation. With the help of digital radiography, special axial images of the injured lower limb are taken. On a computer, these pictures are “stitched” into one picture. Anatomical angles and axes are measured directly on it, and the angle of deformation is calculated.

Then proceed to the corrective osteotomy of the knee joint. This surgery is minimally invasive: it is performed through a small incision and only under X-ray control. The doctor will not do any fraud "by eye", which guarantees a successful outcome of the operation!

The tibia is partially crossed (in medical terms - osteotomy) and the deformity is corrected. Then the zone is fixed in the required position. It is important that modern fixatives do not require external immobilization (for example, plaster overlay).

Features of knee osteotomy:

The duration of the operation is 50 minutes
Stay in the clinic - 3-4 days
Limb loading (e.g. driving a car) – after 6 weeks
Sports activities (skiing, football, running) - after 10 months

The patient is 69 years old. The axial image shows a severe deformity of the knee joint. Same patient 3 months after osteotomy of the knee on the right limb. Preparing for an osteotomy on the left limb.

The patient is 29 years old. Deforming arthrosis of the left knee joint (developed against the background of an injury as a result of an accident 5 years ago). During this time he was treated conservatively. There was no positive effect. Before the operation, the axis of the limb was displaced inward, pain in the knee after physical exertion, swelling and limitation of joint mobility. In April 2012, an osteotomy of the left tibia was performed. The axis was corrected, the excess load on the femoral condyle was removed (pictured). Patient 2.5 months after surgery. The pain disappeared, the range of motion in the joint is full. Walks without additional means of support 8 weeks after surgical treatment.

The patient is 45 years old. Deforming arthrosis of the knee joint stage 2. For a long time I was worried about pain in the knee joint after exertion and at night. She was treated conservatively for a long time: sanatorium-and-spa treatment, intra-articular injections, anti-inflammatory drugs. The expected effect of the treatment was not. Operated by me in May 2012. Osteotomy of the tibia. At the control examination 2.5 months after the operation. There is no pain in the knee, he walks without a cane, the range of motion in the joint is full.

Patient 21 years old, rugby player. Chronic (2 years old) severe injury of the left knee: damage to the anterior cruciate ligament, cartilage defect of the medial femoral condyle (aseptic necrosis), damage to the medial meniscus. Disturbed by severe pain, there was instability in the knee. Pronounced deformity of the joint, defect of the femoral condyle. Completed corrective osteotomy, the anterior cruciate ligament was restored, the cartilage defect was corrected arthroscopically. Postoperative recovery is underway.

Osteotomy is an operation that is performed to cut the bone, which helps to cure certain diseases, both congenital and acquired. Speaking more generally, it is aimed at breaking the bone, after which measures are taken for its further, correct, fusion.

Main types

This method of surgical intervention is used under general anesthesia, and only on the bones of the lower or upper extremities. Today it is customary to distinguish between such types of osteotomy as:

Transverse.
Z - figurative (scarf-osteotomy)
oblique
Staircase.
Angular
Arcuate.
wedge-shaped.

The operation can be performed by closed or open method. In the first case, a small incision is made on the skin - no more than 2 cm long, after which the bone is blindly crossed with a chisel. Moreover, you need to work with a chisel very carefully, and at the very end, when the bones are connected to each other by a small bridge, just break them. This is done to avoid damage to vessels and nerves that may be located deeper than the level of the proposed fracture.

This type is used extremely rarely and in most cases an open osteotomy is used, where everything is done under the strict visual control of the surgeon.

Operation goals

Corrective osteotomy of the knee joint is a very effective operation that helps patients get rid of such a serious pathology as deforming arthrosis. At the same time, it is quite realistic to delay the installation of an artificial joint for a long time, which can be from 5 to 10 years, and sometimes longer.

The meaning of the procedure lies in the artificial fracture of the lower leg and its subsequent connection with plates. As a result, defects that previously prevented patients from leading an active lifestyle are corrected, and after the complete healing of such a fracture, they can again play football, ski, and engage in active sports. At the same time, pain and deformity of the joint disappear for a long time.

Corrective osteotomy can be used for almost any bone of the extremities, whether it be the lower leg, thigh, foot bones, and even fingers.

Contraindications and indications

There are some diseases when such surgical intervention is strictly contraindicated. These include:

Patello-femoral arthrosis of the 3rd degree.
Arthrosis of the contralateral joint.
Obesity.
extra-articular deformities.
Decreased bone regeneration.
The presence of an infectious process.

As for the indications, everything here is strictly individual and everything depends not only on the existing diseases, but also on the patient's age, body weight, and the presence of other pathologies.

For example, an osteotomy of the knee joint can be performed provided that the person is not yet 60 years old. If this age is exceeded, then the issue is resolved strictly individually. Also, the main indications for this surgical intervention include:

2 degrees.
Absence of patellofemoral arthrosis.
The presence of valgus or varus no more than 15 degrees of curvature.
Isolated arthrosis of 2-3 degrees.
Full knee extension.
Intact cruciate ligaments.
Intact menisci of the knee joint.

Preparation and rehabilitation

Corrective osteotomy of the tibia or knee requires careful preparation from both the patient and the clinician.

The patient must undergo a complete examination, which includes blood and urine tests, a biochemical blood test, a blood sugar test, an X-ray examination of not only a possible site of an artificial fracture, but of the entire limb, a fluorographic examination of the lungs, a study for infections such as AIDS, syphilis, hepatitis.

As a rule, the operation is carried out according to plan, the patient can take all the necessary tests at the nearest clinic. On the appointed day, the patient is admitted to the hospital. The length of stay in the clinic after surgery is no more than 5 days. Outpatient rehabilitation can last 4 weeks or more. As for disability, this is decided strictly individually and usually this period is from 2 to 6 weeks. But here it all depends on the place of the osteotomy - foot, knee or thigh.

As for rehabilitation, electromuscular stimulators, magnetotherapy and lymphatic drainage can be used here. It is obligatory to wear an orthosis, which ensures the immobility of the operated bone.

Corrective osteotomy of the knee joint is a surgical intervention aimed at eliminating the deformity of the bone tissue. When planning such an operation, one should prepare for the artificial breaking of a small section of the bone in order to correct the malunion. There are different methods of osteotomy, differing in the level of complexity depending on the presence or absence of comorbidities and the general condition of the patient.

Indications and contraindications

Osteotomy of the knee is most often performed for degradation of cartilage and parts of the joints of the knee, when it is necessary to preserve healthy tissue.

Contraindications for surgery:

rheumatoid arthritis;
local and general infectious diseases;
diseases of the veins and vessels of the legs;
heart and lung diseases in the stage of decompensation;
kidney and liver failure;
obesity or dystrophy;
diabetes;
increased bone fragility.

People who do not fall into the 40-60 age category may be denied surgery due to a low chance of a positive result or the possibility of a more benign treatment.

Correction of the knee joint with an osteotomy is recommended for patients who meet the following characteristics:

mild to moderate arthritis that only affects one knee
middle age category;
optimal weight;
high mobility of the knee joint: the ability to straighten - bend at least 90 degrees;
the presence of pain caused by arthritis and manifested only during the period of activity or prolonged standing;
consent to long-term rehabilitation;
consent to walk with crutches for 6-8 weeks after surgery.

If the operation is carried out correctly, the positive result will remain for a long time.

Preparing for the operation

MRI of the knee

Prior to osteotomy, confirmation of the diagnosis and determination of the amount of bone tissue to be removed is required. Required research:

radiography;
MRI, which uses special magnetic waves to create an image of the structure inside the knees;

A comprehensive examination allows you to understand how high the level of effectiveness of the planned procedure will be.

Before performing an osteotomy, it is recommended to consult a doctor regarding the medications used. You may need to temporarily stop taking certain medications, such as anti-inflammatory and blood-thinning medications, for about a week. This measure increases the effectiveness of surgical intervention.

The operation is done exclusively on an empty stomach, therefore, at least 8 hours in advance, it is necessary to refuse meals, and 3 hours before drinks.

Features of knee surgery

The joints should be corrected until the disease has become more severe and has not led to the loss of the patient's ability to work. With advanced pathologies, arthroplasty is recommended, which involves replacing the affected joint or part of it.

The main task of osteotomy is to normalize the ratios of the surfaces of the knee joints, improve blood circulation in bone tissues. It is possible to remove the load from the affected area, which is subsequently transferred to a healthy limb for full functionality. Stagnation of blood in nearby tissues is prevented, as a result of which the risks of destruction of the cartilaginous tissue of the knees are eliminated.

Result of corrective knee osteotomy

The result of corrective osteotomy depends on the correct calculation of the deformity angle and further surgical correction. To prevent relapse, it is recommended to take 3-4 healthy degrees. Doctors use imaging technology to measure the part of the bone that needs to be removed. Careful control increases the effectiveness of the event.

An incision is made in the skin, and thin wires are placed in the knee to facilitate the removal of the bone. The doctor carefully removes part of the knee joint at a certain angle. The remaining parts are fastened with special medical screws. At the end of the procedure, the tissues are sutured in layers and treated with antiseptics.

Corrective osteotomy of the knee usually takes 1-3 hours, after the operation it is necessary to stay in the hospital for 2-3 days. In some cases, the doctor extends the length of stay in the hospital if he sees complications.

Features of rehabilitation

After corrective osteotomy of the knee joint, rehabilitation is mandatory for the full restoration of knee functions. The set of measures includes:

Taking painkillers.
Cold compresses for 15-20 minutes four times a day.
During rest, the position of the operated leg is higher than the body to eliminate swelling, improve blood circulation and lymph outflow.
Caring for sutures to prevent inflammation, keeping them clean and dry.
Use of crutches or walkers initially. The timing of the use of aids is determined by the doctor.

It is necessary to develop a knee after an osteotomy under the supervision of a physiotherapist after 6-8 weeks. The therapy is based on the gradual expansion of the range of motion and includes strength training.

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

General concepts

The operation of osteotomy is performed by highly qualified trauma surgeons. At first glance, it seems that the intervention is complex and requires a lot of time to recover the patient, but following the recommendations of doctors will quickly raise the patient to his feet.

Osteotomy - which is carried out with the help of special tools - osteotomes, Gigli saws, power saws and ultrasonic devices. They help to make holes at the site of intervention and dissect the bone tissue. After collecting the fragments, the bone fragments are fixed with screws, knitting needles, and plates. Unlike accidental fractures, a plaster cast is rarely applied to avoid the possible development of contractures in the joints.

Classification

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

Open - requires wide access to bone tissue. After an incision of the skin, subcutaneous tissue and muscular apparatus, the periosteum is separated with a raspator, then the bone is dissected. The fragments are fixed in a physiological position, on top - a plaster cast.
Closed - carried out through an access of several centimeters. The muscles are not cut, but stratified to get to the bone tissue. With the help of a chisel, the periosteum is separated and the bone is dissected with a few blows of the hammer on the handle. Vessels and nerves are moved aside and fixed with special instruments to avoid damage. Often used for transverse osteotomies.

The following interventions are distinguished according to the form of dissection:

transverse;
staircase;
oblique;
zigzag;
hinged (spherical, arcuate, wedge-shaped, angular).

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

derotational;
aimed at changing the length of the limb;
aimed at improving the support function.

Indications for intervention

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

congenital or acquired anomalies and deformations of the bone tissue, mostly long (thigh, shoulder, lower leg);
ankylosis - the impossibility of the functioning of the joint due to the presence of adhesions of the connective tissue, cartilage or bone nature of the articular surfaces;
congenital hip dysplasia (dislocation);
fractures that healed incorrectly;
osteomyelitis;
the presence of neoplasms or metastases;
consequences 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 jaw functions.

Contraindications

There are a number of factors in the presence of which surgery is delayed:

diseases of an infectious nature at the time when osteotomy of the bone is necessary or two weeks before surgery;
diseases of the respiratory and cardiovascular systems in the stage of decompensation;
diabetes;
the period of bearing a child;
kidney or liver failure;
the presence of a rash of a purulent or other nature in the place where it is necessary to carry out operational access.

Advantages and disadvantages

The positive aspects of the intervention are the weakening of the pain syndrome (if any) and the restoration of motor functions. For example, an osteotomy of the knee joint will eliminate pain during movement, resume flexion and extension functions, and remove adhesions of the articular surfaces. The disease stops its progression.

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

Possible Complications

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

Complications of any type of osteotomy can be:

infection of the postoperative wound - requires the appointment of loading doses of antibiotic therapy;
displacement of fragments and fragments of bone tissue - reposition is carried out with further fixation;
slow bone fusion - multivitamin complexes are prescribed that contain the necessary trace elements (calcium, phosphorus, magnesium, zinc);
formation requires additional intervention;
paresthesia - 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, it recovers on its own);
rejection of implants - endoprosthesis replacement is necessary.

Corrective osteotomy

Carrying out a similar procedure is used for congenital bone defects, the development of ankylosis or false joints, deformities of the bones of the foot with impaired motor function, to eliminate visual cosmetic defects.

Before the intervention, an x-ray examination is performed to clarify the location of the bone, the place of the future dissection, and the general condition of the bone tissue. If necessary, computed or magnetic resonance imaging is performed. The remaining examinations are prescribed by the traumatologist individually.

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

It is a special structure used in the field of traumatology and orthopedics for fixing, compressing or stretching bone fragments in the required position for a long period of time.

After the operation, a control x-ray is taken to determine the correct fixation.

Complications of corrective osteotomy

Possible complications after the correction of pathological conditions include:

severe pain syndrome, not relieved by conventional analgesics;
breakage of external parts of the apparatus or metal structures;
development of bleeding;
hematoma formation;
displacement of bone fragments relative to each other in any of the planes;
other general complications.

Osteotomy in the field of dentistry and maxillofacial surgery

In the dental field, osteotomy of the jaw is performed, which can act as an independent operation or as a stage of surgical intervention. It is used for displacements or fractures, to correct malocclusion. The incisions are made along the jaw behind the molars.

After fixing the jaw in the physiological position, the fixing zone of the cheeks and chin is applied. Antibiotic therapy is immediately prescribed to avoid the development of suppuration and the formation of osteomyelitis. Several elastic bands are placed between the teeth, the location of which is monitored daily by a specialist. The sutures are removed after 2 weeks, and the screws fixing the jaws after a month, in order to complete the stage of treatment with subsequent orthodontic therapy.

In the field of maxillofacial surgery, a nasal osteotomy is used, which is part of rhinoplasty. Indications for carrying out are:

significant curvature of the back of the nose;
large bones;
the need for bone displacement in relation to the nasal septum.

When performing an osteotomy of the nose, the aesthetic tasks fall on the surgeon: closing the roof of the nose, eliminating the hump and straightening the curvature of the back, narrowing 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 characteristics of a particular patient are taken into account.

Types of osteotomy of the nose:

lateral (marginal), carried out by perforation or linear method;
medial (center);
top;
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, and the required 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 will create conditions for good and proper fusion of bone tissues.

Categories

Popular