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PubMed1998

Postoperative migration of the osteotomy segment stabilized by titanium miniplate osteosynthesis following Le Fort I osteotomy: an x-ray stereometric study.

The aim of the present study was to evaluate whether titanium miniplate fixation prevents postoperative migration of the osteotomy segment following Le Fort I osteotomy and, if not, to evaluate whether postoperative migration varies with the direction and amount of surgical repositioning. In 10 consecutive patients who received Le Fort I osteotomies, postoperative migration of the osteotomy segment was studied in a three-dimensional system by means of x-ray stereometry. Surgical repositioning was recorded by cephalometry in lateral head films obtained before surgery and at 2 days postoperatively. X-ray stereograms were obtained at intervals from 2 days to 1 year after surgery. During the 1-year observation period, significant postoperative migration of the osteotomy segment was found at some stage in nine patients. No correlation between the amount of surgical repositioning and postoperative migration was found. However, a tendency toward superiorly directed postoperative migration of the osteotomy segment, independent of the direction of surgical repositioning, was observed. It is thus concluded that titanium miniplates do not prevent postoperative migration of the osteotomy segment. The weak correlation between the amount of surgical repositioning and postoperative migration of the osteotomy segment indicates that predictions of individual outcomes of surgical corrections are uncertain.

Adolescent↗

PubMed1993

Healing of cancellous bone osteotomy in rabbits--Part II: Local reversal of arthritis-induced osteopenia after osteotomy.

With use of the intravital bone label calcein, we previously identified, by histomorphometry, greatly increased new bone formation and juxtaarticular osteopenia (a high turnover state) in carrageenan-induced experimental inflammatory arthritis of the knee in rabbits. In Part I of this paper, we showed that a large increase in new bone formation after a stable incomplete distal femoral condylar osteotomy of normal bone in the rabbit does not increase bone volume (BV) in normal tissue adjacent to the osteotomy (zone 1). In this study, we performed an osteotomy of bone made osteopenic by experimental inflammatory arthritis. After 4 weeks of healing, we examined new bone formation and BV in five zones around the osteotomy. In zone 0 (the osteotomy gap), new bone formation filled the gap to normal BV, as we found for the normal/osteotomy group. In zone 1 (adjacent to but excluding the osteotomy gap), we found greatly increased new bone formation and a return to normal BV, increased from the osteopenic level induced by experimental inflammatory arthritis. In this model, osteotomy apparently reversed the bone-wasting process of inflammatory arthritis. This effect was not observed in other zones: the lateral condyle that had not been operated on, the metaphysis, or the diaphysis.

Animals↗

PubMed2004

Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: a new technique.

To prevent patella infera in open wedge high tibial osteotomy, a new operation technique was developed. Instead of a proximal tibial tuberosity osteotomy, a distal osteotomy was performed and the tuberosity was fixed with one screw to the tibia. Initial experience in 17 patients was evaluated and compared with results of 20 patients with open wedge high tibial osteotomy with proximal tuberosity osteotomy. Distal tuberosity osteotomy in open wedge high tibial osteotomy appears effective in preventing patella infera.

Adult↗

PubMedDate not supplied

Phalangeal osteotomy versus first metatarsal decompression osteotomy for the surgical treatment of hallux rigidus: a prospective study of age-matched and condition-matched patients.

The surgical options for hallux rigidus in the presence of painful but moderate degenerative metatarsophalangeal joint disease are limited to either joint-destructive or joint-preserving procedures. The following study compared the effectiveness of 2 joint-preservation procedures. Forty-nine patients, with a mean age of 53 years, underwent phalangeal osteotomy and were reviewed at an average 29 months postoperatively. A subsequent group of 59 patients, with a mean age of 51 years, underwent first metatarsal decompression osteotomy and were reviewed at an average 15 months postoperatively. In the phalangeal osteotomy group, 65% of patients were completely satisfied, 24% were satisfied with reservation, and 11% were dissatisfied. Three patients suffered continued metatarsophalangeal joint pain, 3 developed hallux interphalangeal joint pain, and 4 patients developed transfer metatarsalgia. The postoperative decrease from 36 degrees to 35 degrees in mean peak hallux dorsiflexion on walking was not significant. In the first metatarsal decompression osteotomy group, 54% were completely satisfied, 13.5% were satisfied with reservations, and 32% were dissatisfied. Continued metatarsophalangeal joint pain occurred in 2 patients, 18 developed transfer metatarsalgia, and 6 of these patients required lesser metatarsal osteotomy. Peak hallux dorsiflexion during walking increased from 36 degrees to 42 degrees (P < .001). First metatarsal decompression osteotomy will increase joint range of motion but the risk of complication and patient dissatisfaction is less after phalangeal osteotomy. Neither procedure could be considered definitive for hallux rigidus.

Decompression, Surgical↗

PubMed2002

The Weil osteotomy for treatment of dislocated lesser metatarsophalangeal joints: good outcome in 21 patients with 42 osteotomies.

Hardly any surgical methods are available for metatarsalgia caused by a dislocated lesser metatarsophalangeal joint (MTP) that do not sacrifice the joint. We reviewed retrospectively the outcome of 60 metatarsal Weil osteotomies for correction of dislocated lesser MTP joints in 31 patients. Between 1995 and 1996, 31 consecutive patients were treated with a Weil osteotomy at 2 institutions. The Weil osteotomy is an oblique osteotomy of the metatarsal neck and shaft, parallel to the ground surface, that controls shortening of the metatarsal by internal fixation with screws or pins. At an average final follow-up of 30 (24-44) months, all patients were interviewed, using a standardized questionnaire based on the AOFAS Lesser Metatarsophalangeal-Interphalangeal Scale. Recurrent or transfer metatarsalgia, formation of callus, mobility and dislocation of the MTP were noted on physical examination. Dorsoplantar and lateral weightbearing radiographs taken preoperatively and at the time of final follow-up were examined for alignment of the metatarsal heads, subluxation or dislocation and for evidence of nonunion, or malunion of the metatarsal osteotomy. We had excellent results in 21 patients (42 osteotomies). A major complication was plantar penetrating hardware in 10 cases (3 screws and 7 pins). We conclude that the Weil osteotomy is a good method for correcting metatarsalgia caused by dislocation of the MTP joint.

Adult↗

PubMedDate not supplied

Extracapsular base of neck osteotomy versus Southwick osteotomy in treatment of moderate to severe chronic slipped capital femoral epiphysis.

The aim of this study was to evaluate the results of extracapsular base of neck osteotomy and Southwick osteotomy from clinical and radiologic points of view. This retrospective study included 35 hips in 33 patients who presented with moderate to severe slipped capital femoral epiphysis (SCFE) between 1995 and 2001. These patients were divided into two groups according to the type of osteotomy: group A patients (n = 15) were treated by extracapsular base of neck osteotomy and group B patients (n = 18) were treated by modified Southwick osteotomy. Follow-up averaged 3.5 years (range 1-6 years). Clinical and radiologic evaluations were done before and after surgery. All patients were finally evaluated according to the modified Southwick criteria. Group A had 86.7% satisfactory results; group B had 90% satisfactory results. There was no statistically significant difference between the type of osteotomy and the final outcome. The authors believe that both types of osteotomy are equally safe and effective procedures, with minimal risks of avascular necrosis and chondrolysis, in the treatment of moderate to severe chronic SCFE.

Adolescent↗

PubMed1998

Mechanical comparison of biplanar proximal closing wedge osteotomy with plantar plate fixation versus crescentic osteotomy with screw fixation for the correction of metatarsus primus varus.

Proximal crescentic metatarsal osteotomy is a clinically successful technique for correcting metatarsus primus varus in hallux valgus surgery. However, there have been instances of dorsal elevation of the metatarsal head with this technique. Mechanical testing on 10 matched pairs of cadaver feet was performed to evaluate a new technique combining a biplanar closing wedge osteotomy and plantar plate fixation versus crescentic metatarsal osteotomy. The specimens were tested in cantilever-bending mode on an MTS Mini Bionix test frame. The mean load-to-failure values were 127.2 +/- 81.9 N (SD) for biplanar osteotomy with plate fixation and 44.9 +/- 43.3 N for crescentic osteotomy (P = 0.019); the mean stiffness values at the initial portion of the load-deflection curve were 83.11 +/- 73.76 N/mm and 31.95 +/- 43.00 N/mm, respectively (P = 0.012). The biplanar wedge osteotomy with plantar plate fixation demonstrated significantly stronger fixation than the crescentic osteotomy, with higher mean load-to-failure and stiffness values. This newly described technique may provide an acceptable alternative for patients at risk for dorsal elevation of the metatarsal, particularly those who are noncompliant or have osteopenia. Clinical study will determine whether this new technique offers satisfactory long-term results.

Biomechanical Phenomena↗

PubMed2006

Inverted V-shaped high tibial osteotomy compared with closing-wedge high tibial osteotomy for osteoarthritis of the knee. Ten-year follow-up result.

We compared the results ten years after an inverted V-shaped high tibial osteotomy with those of a historical series of conventional closing-wedge osteotomies. The closing-wedge series consisted of 56 knees in 51 patients with a mean follow-up of 11 years (10 to 15). The inverted V-shaped osteotomy was evaluated in 48 knees in 43 patients at a mean follow-up of 14 years (10 to 19). All the patients were scored using the Japanese Orthopaedic Association rating scale for osteoarthritis of the knee and radiological assessment. The pre-operative grade of osteoarthritis was similar in both groups. Post-operatively, the knee function score was graded as satisfactory in 63% (35) of the closing-wedge group but in 89% (43) of the inverted V-shaped osteotomy group. Post-operative radiological examination showed that delayed union and loss of correction occurred more often after a closing-wedge osteotomy than after an inverted V-shaped procedure. Our study suggests that the inverted V-shaped osteotomy may offer more dependable long-term results than traditional closing-wedge osteotomy.

Aged↗

PubMed1990

[Pelvic osteotomies: Salter, triple osteotomy, Chiari. Philosophy, technic, choice, indications].

Pelvic osteotomies were proposed in order to preserve as much as possible of the acetabular cartilage. The aims were twofold: centering of the head of the femur in the acetabulum, to improve its stability; correction of the delay in growth of the acetabulum: there is a potential correction, allowing for the femoral growth, or a passive correction by widening a deep acetabulum. Two types of osteotomy are proposed: reorientation osteotomies (Salter, triple osteotomy) which have both a mechanical and biological effect and widening osteotomies (Chiari), which are in fact extracapsular arthroplasties. All the techniques of reorientation osteotomy are very similar and achieve a reorientation of the acetabulum on the femoral head by varization, retroversion and, when possible, medialization. The Chiari osteotomy, which is technically difficult, should be performed according to the very precise rules described by Chiari.

Adolescent↗

PubMed1999

Nerve and vessel injuries during high tibial osteotomy combined with distal fibular osteotomy: a clinically relevant anatomic study.

Based on our clinical experience and an anatomical study, we examined the conditions under which injury to the popliteal artery, tibial nerve or peroneal nerve and its branches may occur during high tibial osteotomy. In 250 high tibial osteotomies performed in our department, we observed the following intraoperative complications. (1) The popliteal artery was severed in 1 patient and repaired by the same surgical team using a microsurgical technique. (2) A tibial nerve paresis also occurred in 1 patient. (3) In 3 patients, temporary palsy of the anterior tibialis muscle was documented. (4) In 4 other patients, palsy of the extensor hallucis longus occurred. To investigate the causes of these complications in the popliteal artery, tibial nerve and branches of the peroneal nerve, we dissected the neurovascular structures surrounding the area of the osteotomy in 10 cadaveric knees and performed a high tibial osteotomy in another 13 cadaveric knees. We concluded the following. (1) The popliteal artery and tibial nerve are protected, at the level of the osteotomy, behind the popliteus and tibialis posterior muscles. Damage can occur only by placing the Hohman retractor behind the muscles. The insertion of the muscles is very close to the periosteum and can be separated only with a scalpel. (2) The tibialis anterior muscle is innervated by a group of branches arising from the deep branch of the peroneal nerve. In two-thirds of the dissected knees, we found a main branch close to the periosteum, which can be damaged by dividing the muscle improperly or due to improper placement and pressure of the Hohman retractor. This may explain the partially reversible muscle palsy. (3) The extensor hallucis longus is also innervated by 2-3 thin branches, arising from the deep branch of the peroneal nerve, but in 25% of the specimens, only one large branch was found. This branch is placed under tension by manipulating the distal tibia forward. Thus, it may be damaged by the Hohman retractor during distal screw fixation, tensioned by hyperextension or directly injured during midshaft fibular osteotomy.

Cadaver↗

PubMed1995

Mobility of the osteotomy site following Le Fort I osteotomy stabilized by titanium plate osteosynthesis.

PURPOSE: This study analyzed whether titanium plate osteosynthesis prevents mobility after Le Fort I osteotomy and, if not, how long the osteotomized segment is mobile. PATIENTS AND METHODS: In 10 patients aged 17 to 49 years, three metal bone markers were inserted below and three above the osteotomy during the Le Fort I procedure, each set forming a triangle. The patients were examined at intervals until 1 year postoperatively. At each examination two sets of x-ray stereograms were obtained; one in rest and one with pressure applied to the anterior part of the maxilla. The difference in position of the maxillary segment in relation to the reference segment between the two sets of stereograms, ie, the mobility, could thus be recorded. Findings of 0.4 degrees and 0.2 mm are considered significant. RESULTS: Immediately after surgery mobility in the osteotomy site was found in 7 of the 10 patients. One year postoperatively mobility in the osteotomy site was still found in four patients. CONCLUSION: Titanium plate osteosynthesis does not prevent mobility between the osteotomy segments after Le Fort I osteotomies. The osteotomized segment may remain mobile at least until 12 months after surgery. During this period the impact of the functional matrix may cause migration of the segment.

Adolescent↗

PubMed1987

Stability of the osteotomy site after oblique sliding osteotomy of the mandibular rami. A stereometric and plain radiographic study.

Displacement of the mandible 2-2 1/2 years after oblique sliding osteotomy of the mandibular rami is reported. Stability of the osteotomy site has been assumed to be complete much earlier, however. In the present stereo radiographic study mobility at the osteotomy site was recorded as late as 2 years after surgery. No sign of delayed healing was recorded in the plain radiographic examination. It seems possible that relapse after oblique sliding osteotomy continues as long as the functional matrix can influence an unstable osteotomy site. As plain radiography does not give full information on the quality of bone, the stability of the osteotomy site can not be assessed by this method.

Adolescent↗

PubMed2001

Preoperative planning for lower extremity osteotomies: an analysis using 4 different methods and 3 different osteotomy techniques.

Lower extremity osteotomy is a common procedure for managing deformity and unicompartmental gonarthrosis. One consideration not typically addressed is how the osteotomy will affect the leg length of the extremity. This article presents a numerical analysis of apparent leg-length change before and after osteotomy surgery. It also compares the differences resulting from the 3 different major types of osteotomies (closing wedge, opening wedge, and dome). Three different preoperative planning methods and a fourth intraoperative technique were studied. Using different methods of preoperative planning with the same osteotomy technique resulted in leg-length changes of 0.5 to 3 mm. Differences > 7 degrees in lower extremity alignment may result depending on the planning method used. When comparing osteotomy techniques, 2 cm in leg-length difference was calculated.

Biomechanical Phenomena↗

PubMedDate not supplied

Peroneal nerve injury as a complication of pediatric tibial osteotomies: a review of 255 osteotomies.

A retrospective study of 255 consecutive tibial osteotomies performed for correction of frontal, sagittal, and rotational deformities in children is presented. Eleven (4.3%) peroneal neurapraxias were identified; seven were motor and sensory (2.7%), and four were sensory only (1.6%). In all cases, traction on the peroneal nerve, either by intraoperative retraction, or by anatomic displacement of the osteotomy fragments, was felt to produce the neurapraxia. There were no vascular injuries or compartment syndromes. Increased patient age, estimated blood loss and tourniquet time, difficulty in exposure, and male sex were associated with an increased risk of peroneal neurapraxia. Rotational osteotomies were of little risk for peroneal nerve injury, whereas angulatory osteotomies, particularly proximal procedures, were more prone to complication. Prophylactic anterior compartment release and fibular osteotomy are recommended to avoid anterior compartment syndrome after tibial osteotomy. In cases of persistent peroneal nerve palsy due to suspected anatomic traction and displacement, exploration of the peroneal nerve is warranted.

Adolescent↗

PubMed1994

Comparison of stability of proximal crescentic metatarsal osteotomy and proximal horizontal "V" osteotomy.

Proximal metatarsal osteotomies are often performed in patients with hallux valgus and significant metatarsus primus varus. The crescentic osteotomy is popular; however, some authors have reported malunion of the metatarsal shaft caused by dorsal angulation of the osteotomy in a significant number of cases. Recently, proximal transverse "V" osteotomies have been reported to have good results, with rapid healing and no dorsal malunions. We compared the stability of a transverse, proximal "V" osteotomy, using two 0.062-inch K-wires or a 3.5-mm cortical screw for fixation, with that of the proximal crescentic osteotomy, using a 3.5-mm cortical screw fixation. The three osteotomy/fixation techniques were performed on 30 fresh-frozen cadaver feet. The specimens were loaded to failure at the fixation site by applying a load through the plantar surface of the first metatarsal head. Force versus displacement curves were obtained to calculate the failure load and stiffness. Statistical differences among the three groups were determined by the nonparametric Mann-Whitney U-test and the standard t-test. The "V" osteotomy/screw group was more stable than either the "V" osteotomy/pin group or the crescentic osteotomy/screw group. Differences in failure strength between the "V"/screw group and the other two groups were significant at the P < .01 level and the differences in stiffness were significant at the P = .05 level. No statistical differences were found between the "V"/pins and the crescentic/screw groups.

Biomechanical Phenomena↗

PubMed1989

Osteotomy length and postoperative stability in vertical subcondylar ramus osteotomy.

The osteotomy sites in 80 patients treated for mandibular prognathism by intraoral (IVSO) or extraoral (EVSO) vertical subcondylar ramus osteotomy and their relationships to post-operative mandibular stability were studied. A model study demonstrated that metric orthopantomographic measurements of the ramus showed insignificant variability of magnification and distortion. The relative osteotomy length and the bony overlapping area of the osteotomized fragments were evaluated on 6-week postoperative orthopantomograms. High correlation was found between the clinical estimate of osteotomy length and metric registrations. Bony overlapping area of the IVSO and the EVSO group did not reveal differences. The mandibular positional changes during the fixation/postfixation periods were analyzed on 6-week and 6-month postoperative lateral cephalograms. Significant correlations could not be demonstrated between postoperative stability and osteotomy length or overlapping bony area. Thus the osteotomy length appears to be factor of minor importance for postoperative stability.

Adolescent↗

PubMed2001

Postoperative migration at the individual osteotomy site following sagittal split ramus osteotomy: a stereometric radiographic study.

The aim of the present study was to evaluate whether migration occurs at individual osteotomy sites following sagittal split osteotomy of the mandible stabilized with rigid internal fixation, and if it occurs, how long it lasts. In 10 consecutive patients operated with bilateral sagittal split osteotomies, postoperative migration, defined as displacement of the proximal segments in relation to the distal over time, was studied 3-dimensionally by means of stereometric radiography. Follow-up was performed with stereometric radiographs obtained at intervals from 2 days until 1 year after surgery. During the 1-year observation period, migration at one or both of the osteotomy sites was found at some stage in all of the patients and in as many as 4 patients during the final 6 months. It is concluded that rigid internal fixation, as performed in the present study, does not prevent postoperative migration at the osteotomy. Furthermore, stable bone union at the osteotomy site appears to be a slower process than previously expected, thus emphasizing the importance of follow-up procedures to prevent relapse.

Adolescent↗

PubMed2001

The fronto-orbital osteotomy as plastic-reconstructive approach to the anterior and middle skull base.

Introduction: A combined extra-intracranial access for the operative exploration of tumours of the anterior and middle skull base is indicated when the tumour extends intracranially and simultaneously into the nasal cavity, the paranasal sinuses or the orbit. Methods: Two standardized modifications of the fronto-orbital osteotomy, the fronto-orbito-nasal and the fronto-orbito-zygomatic osteotomy, allow safe removal of skull base tumours in these locations. In extensive skull base tumours, a modified bilateral fronto-orbital-zygomatic osteotomy can be used. Results: Between February 1993 and July 2000 skull base tumours in 111 patients were resected using the presented methods. The most frequent tumour type was meningioma in 29 cases. Complications were encountered in 13 cases (11.7%). Conclusion: The advantages over other approaches are good extra- and intracranial overview and minimal cerebral trauma. Additional transfacial incisions are not usually necessary. Exact repositioning of the fronto-orbital segments leads to optimal aesthetic results. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.

Journal Article↗