J Korean Fract Soc.  2017 Jul;30(3):167-172. 10.12671/jkfs.2017.30.3.167.

Osteotomy Selection: Advantages, Disadvantages, and Indication

• Park KC
• Kim HU
• Song YS

• KMID: 2424127
• DOI: http://doi.org/10.12671/jkfs.2017.30.3.167

Abstract

Malunion causes not only cosmetic problems, but also degenerative osteoarthritis due to changes in the anatomical and mechanical axes. Corrective osteotomy may be required in some cases to prevent these complications. The corrective osteotomy is divided into two types: Straight and dome. The straight type is divided into open and closed wedge, in accordance with the correction method. Surgeons should understand the indication, surgical procedure, as well as the advantages and disadvantages of each osteotomy method. Deciding on the method of corrective osteotomy depends on the degree of angulation, soft tissue condition, approximate with joint, implant type, and the experience of the surgeon.

Keyword

Osteotomy; Fractures; Malunited

MeSH Terms

Joints
Methods
Osteoarthritis
Osteotomy*
Surgeons

Figure

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  Fig. 1 (A) There was valgus malalignment after tibia nailing. Closing wedge osteotomy was planned and angulation correction axis-center of rotation of angulation (ACA-CORA) was on the concave axis. (B) Intramedullary nail was inserted after the closing wedge osteotomy. (C) Postoperative 6 months radiography shows good alignment with bone union. MPTA: medial proximal tibial angle, LDTA: lateral distal tibial angle.

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  Fig. 2 (A) There was a varus malalignment after distal femur minimally invasive plate osteosynthesis (MIPO). Open wedge osteotomy was planned. (B) The plate was removed through the previous operation site. (C, D) Two shanz pins were inserted into the medial side for deformity correction. (E) Osteotomy was performed at the center of rotation of angulation. (F, G) Two shanz pins were distracted until the mechanical axis showed normal alignment. (H, I) Locking plate was applied using the MIPO technique. (J) Postoperative 10 months radiography shows good alignment with bone union (image courtesy of CW Oh, MD, Kyungpook National University, thank you for your courtesy).

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  Fig. 3 (A) When the center of rotation of angulation (CORA) and angulation correction axis (ACA) are not the same, dome osteotomy will cause translation of the proximal and distal bone axes. (B) When the CORA and ACA are the same, dome osteotomy will correct the angulation deformity without translation.

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  Fig. 4 Graphic method. (A) Magnitude of angulation angulation was measured on anteroposterior (AP) and lateral radiographs (1 mm=1°). True deformity angle was 45° and 30° from the sagittal plane. (B) Closed wedge osteotomy is performed on the forward angulation correction axis (ACA), and opening wedge osteotomy is performed on the backward ACA.

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  Fig. 5 (A) There was a valgus malalignment after proximal femur minimally invasive plate osteosynthesis (MIPO). (B) The angle of 40° internal rotation deformity was found on the computed tomography and physical examination. (C) Two parallel shanz pins were inserted into the proximal and distal segments to correct the rotational deformity after plate removal. (D) Osteotomy was performed at the center of rotation of angulation. (E) Distal shanz pin was externally rotated until the lessor trochanter shape showed to be the same as the opposite site. (F) The plate was bent 8° varus compared with the previous plate to correct the valgus deformity. (G) Locking plate was applied using the MIPO technique. (H) Postoperative 4 months radiography shows good alignment.

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