Osteotomy | EPFL Graph Search

An osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture. It is also used to correct a coxa vara, genu valgum, and genu varum. The operation is done under a general anaesthetic. Osteotomy is one method to relieve pain of arthritis, especially of the hip and knee. It is being replaced by joint replacement in the older patient. Due to the serious nature of this procedure, recovery may be extensive. Careful consultation with a physician is important in order to ensure proper planning during a recovery phase. Tools exist to assist recovering patients who may have non–weight bearing requirements and include bedpans, dressing sticks, long-handled shoe-horns, grabbers/reachers and specialized walkers and wheelchairs. Two main types of osteotomies are used in the correction of hip dysplasias and deformities to improve alignment/interaction of acetabulum – (socket) – and femoral head (femur head) – (ball), innominate osteotomies and femoral osteotomies. The bones are cut, reshaped or partially removed to realign the load-bearing surfaces of the joint. Adjustments are made to part of the hip-bone. Many operating methods and variations have been developed. They are defined by the type of cut and adjustment made. Some acetabular procedures are named after the surgeons who first described them as Salter (R. Salter), Dega (W. Dega), Sutherland (D.H. Sutherland), Chiari (K. Chiari): other names one may encounter are Ludlov, P. Pemberton, and James B. Steele. Some are named after the shape of cut (e.g. Chevron, Wedge) or the way the bones are aligned (Dial=old style rotary dial phone). A femoral derotation osteotomy can be performed to correct version abnormalities such as excessive anteversion or retroversion of the hip joint. Excessive anteversion of the femur results in anterior instability of the hip joint while excessive retroversion results in femoroacetabular hip impingement.

Predrilled locking compression plate is more accurate than tension band wiring in restoring articular geometry of the ulnar greater sigmoid notch after olecranon Chevron osteotomy

Alexandre Terrier, Patrick Goetti, Frédéric Vauclair

Introduction: The olecranon Chevron osteotomy (OCO) is commonly used to approach complex intraarticular fractures of the distal humerus. Predrilled tension band wiring (TBW) has historically been used to fix OCO. However, clinical outcomes are burdened by secondary loss of reduction and up to 21.3% non-union rates. The biomechanical stability of anatomic locking compression plate (LCP) was reported to be superior to TBW in olecranon fracture fixation. We hypothesised that this implant may also be superior to TBW in the anatomic reconstruction of the articular surfaces of the ulnar greater sigmoid notch after OCO by predrilling the holes of the angular stable plate with the threaded drill guide prior to osteotomy. Materials and methods: Lateral standardised and calibrated radiographs of twenty synthetic ulnar bones were obtained using a custom-made holder prior to preparation by a senior orthopaedic trauma surgeon. Ten specimens were then predrilled using the threaded drill bit guide of an olecranon LCP, while the other ten samples were predrilled with two 1.6 mm Kirschner wires. A distal "V" OCO was performed using a 0.6 mm oscillating saw. After repositioning and fixation with the corresponding device, lateral radiographs were repeated. Two independent observers used the TraumaCad planning software to document the articular geometry of the ulnar greater sigmoid notch pre- and postoperatively. The diameter of the best-fitting circle (diameter), the distance between the tip of the coronoid and the olecranon processes (distance) and the maximum articular depth were measured. Results: With the TBW technique, after OCO and fixation, all three postoperative measurements were significantly (p = 0.13). Inter and intra-observer measurement reliability was strong to very strong (intraclass correlation coefficients >= 0.793) for all three variables. Conclusion: Our study reveals that the predrilled LCP technique is more accurate than the predrilled TBW in restoring the anatomic articular geometry of the ulnar greater sigmoid notch after OCO. (C) 2020 Elsevier Ltd. All rights reserved.

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Predrilled locking compression plate is more accurate than tension band wiring in restoring articular geometry of the ulnar greater sigmoid notch after olecranon Chevron osteotomy

Alexandre Terrier, Patrick Goetti, Frédéric Vauclair

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