Osteotomy

Osteotomy is the intersection of the bone to correct deformities, congenital and acquired (for example, inappropriate methods of fracture). Depending on the purpose (extension, or straightening crooked bones etc) produce osteotomy cross, curved, oblique, manual and other, often under local anesthesia. Necessary instruments: osteotomy, chisels, saw Gigli or electric saw. Selecting fragments into a new position, they are fixed by osteosynthesis (see) or a plaster cast.

Osteotomy (from the Greek. osteon - bone and tome - dissection) is a surgical operation that produces artificial bone fractures with the aim to eliminate the deformation or to improve the function of the leg. Osteotomy is a bloody operation, unlike steakley, at which artificial fracture produce bloodless.
Osteotomy, as a rule, apply to the extremities. After performing O. limbs give the desired position: on the lower extremities convenient for statics and walking on the upper - for self patient in private life and professional work. Installed a new position fragments fix the osteosynthesis (see) or a plaster cast. O. there are both under the form of the created fractures, and for the intended purpose ongoing operations.
Depending on the direction of the artificial fracture tibial be linear (transverse and oblique); Z-shaped; ladder; articulated in one plane (arc) or in several planes (spherical); angular; wedge-shaped with the removal of a wedge or move it to the opposite side (Fig. 1). More complex, in several places and in different directions, crossing bones carried out at the fork Acting on N. P. Novachenko and when Acting (metaplasia) by R. R. the Vreden. When segmental O. bone cross in several places, but in the same direction - obliquely (Fig. 2) or cross (Fig. 3).

Fig. 1. The main types osteotomy: 1-cross; 2 - oblique; 3 - Z-shaped; 4 - staircase; 5 - arc; 6 - angular; 7 - wedge.
Fig. 2. Slash segmental osteotomy on Bogoraz.
Fig. 3. Cross-segmental subperiosteal osteotomy on Springer that resolves arched deformation of bones.

For osteotomy apply osteotomy - flat bit different widths, for articulated globularia bit. For corner O. proposed bit with oblique cut the cutting edge different angles. To facilitate the operation is possible to drill preliminary bone along the lines proposed O. and cutting such gaps of pliers.
Osteotomy can be closed and open. When closed, O. make a small incision (about 2 cm), muscle layer and the periosteum blindly cut with a chisel, placed lengthwise, then it is turn across dlinnie bones and a few strokes of a hammer cross it. Better crossing not to bring to an end, and the remaining bridge bones to break manually to avoid damage to smash of deep vessels and nerves.
Closed way suitable only for control osteotomies, all other produce in the open way: through the broad skin incision under the control of eyes cut through the muscles and (if subperiosteal O.) the periosteum, hooks pulled the soft tissues, the periosteum prepare the chin by aspatore, under bone fail defenders - elevators - and then cross it. When periosteal O. bone cross together with the failure to separate the periosteum. After hemostasis the wound is sutured in layers (skin catgut), attach limbs desired position and fix the plaster cast.
In the area of the hip joint with ankylosis in the tuberculosis
or other caxita position bending, cast and internal rotation of the hips causes difficulties with walking and functional LLD; in such cases do podfartilo osteotomy - lateral, angular, or slash. R. R. Vreden proposed in these cases spherical O. Slash segmental About. except the deformation, allows to extend limb using skeletal traction sometimes 6-7 cm (Fig. 4).

Fig. 4. The result of lengthening segmental osteotomy of the femur.
Fig. 5. The result wedge osteotomy of the femur neck with the movement of the wedge.

At coxa vara or valga used wedge osteotomy of the femur neck. In the first case excised wedges, base directed outwards, in the second turn in. Seized wedge can be inserted on the other side of the turning point, when the neck is not shortened (Fig. 5). Bone fragments into position holding the bone pins, metal nails and brackets various forms (Fig. 6).

Fig. 6. Osteotomy with congenital hip dislocation with bracket Revenko (scheme).
Fig. 7. The results of the operation poppy-Marri: 1 - hip operations, pseudoarthrosis of the cervix: 2 - consolidation occurred after the operation.

When pseudoarthrosis cervical hip successfully apply the operation poppy-Marri. Cross horizontally podfartilo thigh at the level of the lower part of the head, and in further promoting the bit cut off the lower part of the femoral head. The diaphysis hips move inwards so that the plane of its cross section was established under the line of pseudoarthrosis (Fig. 7). The growing fusion between the three fragments creates stability limbs.
When the defects of the head and neck of the femur after injuries, inflammatory processes N. P. Novachenko recommends osteotomy on the level of the greater trochanter; the latter is deflected to the side of the acetabulum and serves as the likeness of the head (Fig. 8). When another modification N. P. Novachenko O. produce vertically through the stump of the hip, medial part dissected Department naglasavajuci and implement joint and socket. This creates a fork, one leg of which performs the role of a head and neck, and the other big spit (Fig. 9).

Fig. 8. Deviation osteotomiate big spit in joint and socket on Novachenko.
Fig. 9. Fork osteotomy on Novachenko.

Within the diaphysis hips when rachitic curvature apply corrective O. corner or a wedge.
N. A. Bogoraz for lengthening limb was proposed slash segmental osteotomy of several sections. Bone cross together with the periosteum and traction reach lengthening. To correct curvature Springer (Springer) did cross-segmental O. subperiosteal and wide detachment of periosteum in the form of cover. You can also give osteotomiate the ends of the ladder shape, but this operation is technically difficult. When segmental Acting simultaneously with the traction produce attorney correction.
In namyslowski hip often produce corrective Acting with deformation of the knee joint (type varum or valgum), as well as the conservative fatal contractures, paralysis of the quadriceps muscle of thigh after polio. The most appropriate is the angular osteotomy on the turnip (Fig. 10).



Fig. 10. Angular namasakata osteotomy of the femur at the turnip.
Fig. 11. Operation Vreden (metaplasia); right there in the corner - the scheme of the operation.
Fig. 12. Wedge negadijuma osteotomy of the tibia.

When you reject the bottom of the fragment in one direction or another is their incursion into each other and do not require additional fixing. When operations R. R. Vreden (metaplasia) after crossing the hip in the field of metaphysis bore through an aperture in the proximal portion and it is inserted at an angle respectively cut the end of the distal fragment (Fig. 11). After the Union remains available to the degree of mobility in the joints, but in the best functional position. Paralysis of the quadriceps muscle of thigh with the help of osteotomy is created reservace. At first glance antipathological, however, you can close the knee, as the center of gravity moved forward.
Within the Shin produce corrective Acting on the highest levels of curvature at rachitic curvature (Fig. 12)and in the lower third limb - after correctly fused negadijumi fractures (crus varum, valgum or antecurvatum); this produces the Acting both bones by linear or angular intersections.
O. humerus shown incorrectly when fused fractures of diaphysis in the middle third, and more frequently when razmyslovich fractures. On the forearm denotational O. produce on a considerable limitation pronation or supination.
Within feet of O. recommend with deformation type hallux valgus. To improve cross I metatarsal bone or repetiruyut her head.
When Acting use different types of anesthesia: intraosseous, conduction anesthesia, endotracheal anesthesia.
When osteotomy may be a number of complications - displacement of bone fragments, damage to blood vessels and nerves, suppuration. Careful operation and compliance of asepsis guarantee a good outcome her so much that Acting almost entirely supplanted method osteoclasis (gr. osteon - bone and klasis - fracture), i.e. the application of a closed fracture of the same goals as the Acting Lack osteoclasis is a significant injury of soft tissues, inevitable at this way, and lack of confidence that the bone will break it in the planned place. Sometimes osteoclasis used in combination with O.: bone AgroBalt osteotomes entered through a tiny incision tissues, and then break a hand fracture.