Definition
An osteotomy is a controlled surgical division of bone performed to alter alignment, length, rotation or load distribution.
Indications
- correction of angular deformity
- correction of rotational deformity
- limb-length correction
- joint-preserving realignment in unicompartmental arthritis
- congenital or post-traumatic deformity
- selected reconstructive procedures around the hip, knee, ankle and upper limb
Types
Opening-wedge osteotomy
Creates a gap on the opening side and generally lengthens the bone. It often requires a graft or substitute depending on gap size and fixation.
Closing-wedge osteotomy
Removes a wedge of bone and generally shortens the bone. It provides broad bony contact.
Dome osteotomy
Allows angular correction around a curved cut with relatively broad contact and less translation.
Rotational osteotomy
Used to correct abnormal torsion while maintaining the desired coronal and sagittal alignment.
Planning principles
- define the deformity in all relevant planes
- identify the CORA
- calculate the correction angle
- select osteotomy level and hinge position
- anticipate length change and translation
- choose fixation that provides the required stability
Complications
- neurovascular injury
- non-union or delayed union
- loss of correction
- fracture through the hinge
- infection
- overcorrection or undercorrection
- compartment syndrome in selected procedures
Rehabilitation
Weight-bearing and range-of-motion progression depend on osteotomy type, fixation stability, bone quality and radiographic healing.