Osteotomy

The osteotomy (from the Greek ὀστέον "bone" and τομή "cut") describes a surgical procedure that has been used in surgery since around 1825 , in which one or more bones are deliberately severed.

Osteotomies are used, for example, to correct malpositions such as non-physiological leg axes (bow or knock knees) or hip malpositions (congenital hip dislocations). This is called a conversion osteotomy or a correction osteotomy . The osteotomy is usually followed by an osteosynthesis , often performed as a plate osteosynthesis, in order to fix the severed bone parts in the new, desired position.

In addition, osteotomies are also used in many other areas, e.g. B. in dental surgery as a "tooth osteotomy" (when removing wisdom teeth) or in oral surgery as a jaw osteotomy (moving the jawbone).

Often, osteotomies are also necessary to gain surgical access to deeper organs. This applies to the osteotomy of the sternum or ribs for cardiac or pulmonary surgery. In orthopedics, the osteotomy of the medial ankle is known in order to obtain better access to the talus , or of the greater trochanter on the thigh , in order to obtain better access to the acetabulum , especially with revision hip prostheses . In the case of osteotomies as part of an operative access route, an osteosynthesis is usually carried out at the end, often as a wire cerclage on the greater trochanter.

In order to better plan the operation and, especially in the case of complex osteotomies, to be able to specifically achieve the best possible position during the operation , patient-specific templates and brackets produced in the 3D printer can also be used. However, this requires a 3D reconstruction using a thin-slice CT .

Commonly used osteotomies

• DVO (derotation varization osteotomy): In the case of malpositions of the hip joint, which are classified as pre-arthrotic deformity, the thigh shaft is severed below the rolling hillock or trochanter, a bone wedge precisely calculated at an angle is removed and the femoral neck is fixed again with a perforated metal splint called a blade plate screwed to the thighbone.

Unfolding medial tibial head conversion osteotomy ( open wedge ) with plate osteosynthesis. The black arrows indicate the load distribution before and after the changeover.

• TKO (Tibial Head Osteotomy) : For example, in the case of a varus malposition of the knee joint, the tibia can be severed from the outside (laterally) just below the articular surface of the knee joint and a wedge calculated in its angle before the operation can be removed ( closed wedge surgical technique ), or it takes place in the open wedge - osteotomy a passive pop osteotomy from the medial (inside) without wedge removal, so that a gap remains, but which accrues with the bone healing. In both procedures an osteosynthesis , e.g. B. as a plate fixation or by means of brackets, the two bone fragments hold stable in the desired position until the bone heals. If the lateral part of the knee joint does not yet show severe wear in varus gonarthrosis , the prosthetic replacement of the knee can be delayed for a few years or even prevented. Conversely, a valgus malposition of the knee joint with knock knees can also be used on the shin, with the open-way de-osteotomy on the outside or the closed-wedge osteotomy on the inside, also with subsequent stable osteosynthesis.
• Operation according to Maquet-Bandi : Some problems with the patella sliding bearing can be treated by chiseling the insertion of the hamstring out of the shin together with a strong block of bone, shifting it to the side and front and screwing it into place.
• Swivel osteotomy near the base of the first MFK (metatarsal bone): In the case of foot deformities in the sense of hallux valgus , the first metatarsal bone is severed near the base and, after correcting the position, is fixed again with a perforated plate or drill wires.
• Chiari pelvic osteotomy : Sometimes the roof of the joint socket of a hip is not wide enough. The load distribution in the hip joint is then unfavorable, and premature wear is to be expected. During the operation, the pelvic bone is severed directly above the hip joint, the joint is pivoted outwards and the new position is held with screws or drill wires. The goal is to widen the pan roof of the hip.
• Extension osteotomy: Due to accidents, but also due to congenital defects, one leg can be significantly shorter than the other. A difference of up to 2 cm can easily be compensated for by adjusting the shoe accordingly. If there is a difference of 4 cm or more, it can make sense to surgically lengthen the affected bone. The most common procedure is callus distraction with a transverse osteotomy or corticotomy and then slowly pulled apart using a distractor . This is usually followed by an intramedullary nail or plate osteosynthesis in order to allow the bone to heal again as soon as the desired extension has been achieved. Alternatively, adjustable intramedullary nails can also be used, which can just as slowly be telescoped out, thus avoiding the external fixator. A step-shaped osteotomy is also possible for extensions of up to 4 cm, whereby the thigh is divided lengthways in the middle. This is particularly possible in the subtrochanteric region of the transition between the proximal femoral metaphysis and diaphysis. The necessary extension can be set directly during the operation and fixed using angled plate osteosynthesis.
• Dental osteotomy: This procedure is also used in oral surgery, e.g. B. to enable the extraction of wisdom teeth .
• Maxillary osteotomy: relocating or relocating the jawbone, e.g. B. Lengthening or shortening of the lower jawbone or shifting of the upper jaw. See also Chin Wing and Genioplasty
• Femoral neck osteotomy : Especially in dogs with hip problems for resection of the femoral head , also part of the operation when inserting a hip prosthesis , in which the femoral head is also resected. The femoral head can also be removed independently, e.g. B. in infectious arthritis of the hip joint, and was before the time of the endoprosthesis under the term Girdlestone surgery a standard procedure.
• Laminectomy of the spine (removal of the vertebral arch with the spinous process of one or more vertebrae)

Osteotomies used rarely or in the past

• Drehkopfosteotomie : After a Hill-Sachs lesion or Humerustorsionsfehlers the proximal humeral head from the rest of the humerus separated and fixed again by rotation.

Individual evidence

1. ^ Doris Schwarzmann-Schafhauser: Joint surgery. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 467 f.
2. ↑ JA Mayer: The osteotomy as a new orthopedic surgical procedure. In: Negotiations of the physical-medical society in Würzburg. Volume 2, 1851, p. 224.
3. ↑ Description of the technique of patient-specific templates. materialize.de

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