Osteotomies
Osteotomies are among the conservative surgical techniques that can, in particular, correct a bone axis defect or reorient joint surfaces functioning under poor mechanical conditions.
What is an osteotomy?
An osteotomy is a surgical procedure that involves creating a discontinuity within a bone, meaning separating a bone into two parts to allow for the correction of its deformity or the reorientation of a joint surface.
The osteotomy, which can also be considered the surgical sectioning of a bone, may be complete, or incomplete and preserve a bony hinge to increase the stability of the correction.
In the case of complex bone deformities, several osteotomies can be combined on the same bone.
For which conditions is an osteotomy performed?
Vicious extra-articular malunions of fractures
These malunions correspond to a bone or multiple bones healing in a poor position, leading to a misalignment of a preserved articular surface. This misalignment results in harmful mechanical conditions for the cartilage, with a risk of osteoarthritis in the short to medium term.
Articular malunions of fractures
This refers to bone segments healing in poor position, resulting in abnormalities—one of the anomalies of congruence of the intra-articular cartilaginous surfaces that are potentially highly damaging to cartilage.
Ankle osteoarthritis
When there are extra- or intra-articular deformities contributing to established ankle osteoarthritis, it is sometimes possible to perform so-called palliative corrective osteotomies in certain cases, in hopes of giving the ankle joint a second life. The goal is to avoid or postpone a non-conservative procedure such as a total ankle replacement or an ankle arthrodesis.
The different types of osteotomy
Supramalleolar osteotomy
Supramalleolar osteotomies are extra-articular osteotomies involving the tibia and fibula. These osteotomies allow for the reorientation of the articular surfaces of the ankle. The goal is to achieve an orientation of the ankle joint surfaces parallel to the ground.
Malleolar osteotomy
Malleolar osteotomies are intra-articular for the medial malleolus and may be extra- or intra-articular for the lateral malleolus. They allow for the correction of articular malunions in ankle fractures that are untreated or insufficiently treated. These osteotomies are always more difficult to perform than the initial surgical treatment to stabilize ankle fractures.
Calcaneal osteotomy
Calcaneal osteotomies can be extra-articular, in which case they are performed percutaneously. They may also be intra-articular. These corrective osteotomies make it possible to correct a hindfoot axis defect, but also to address conflict syndromes such as Haglund's deformity or insertional tendinopathy of the Achilles tendon.
Metatarsal osteotomy
Metatarsal osteotomies are performed for the surgical correction of hallux valgus, the correction of certain cases of hallux rigidus, for metatarsalgia, and tailor's bunions.
Phalangeal osteotomy
Phalangeal osteotomies can be performed for additional correction of hallux valgus. They also allow for the correction of certain hammer toes, as well as addressing problems related to long toes.
Tibial osteotomy
If the tibial osteotomy allows for harmonizing pressures within the knee to limit painful hyperpressure phenomena in some cases of knee osteoarthritis, it may also be used to indirectly reorient the ankle joint to allow it to function under better mechanical conditions.
How does a foot osteotomy take place?
Corrective osteotomy procedures are surgical actions that must be anticipated and planned. It is necessary to analyze the deformity to be corrected in all spatial dimensions.
A deformity is rarely confined to a single plane of space.
It is important to consider the correction to be made in length, translation, height, and rotation. It is this correction in all planes that makes the surgical procedure difficult in certain cases, especially in the management of hallux valgus where it is necessary to take into account joint deformities and defects in the orientation of the cartilage surfaces.
FAQ
This depends on the postoperative period after the osteotomy and the location of the painful osteotomy. Osteotomies usually consolidate within 1 to 4 months in the foot and ankle. Pain is possible as long as the osteotomy is not solid.
In case of delayed consolidation, this is a pseudarthrosis which may consolidate later.
An osteotomy can shift secondarily and cause pain. The question then will be whether the displacement is tolerable or if further surgery is necessary.
The duration of recovery after an osteotomy depends on the degree of correction, the need for a graft and its type, and the consolidation of the osteotomy.
There is no specific percentage or success rate for an osteotomy; overall, an osteotomy is considered successful when the surgical result is deemed satisfactory or very satisfactory by the patient.