Prof. Marco Massobrio, expert in Orthopedics and Traumatology in Rome, talks about the osteotomy associated with external fixation, two techniques that, combined, have opened the way to various therapeutic possibilities
What is Osteotomy?
Osteotomy consists in breaking the continuity of the bone, ie cutting it, to modify the axis of the segment and obtain, once the bone is consolidated, the correction of the deviation of the axis. It is the most classic surgical intervention when it comes to deformity, joint pathologies and diaphyseal diseases, as it does not involve any functional or part sacrifice.
Osteotomy associated with external fixation
In some areas, the use of prostheses has reduced the number of osteotomy interventions; in others, however, the association of osteotomy and external fixation has opened the way for new therapeutic possibilities. In fact, the development of external fixation techniques and the possibility of simultaneously performing multiplanar corrections with computerized systems (Computer Hexapod Assisted Orthopedic Surgery, CHAOS), has extended the indication to the osteotomy of all the deformities of long bones.
External fixation has meant that the osteotomy is now applicable to the entire bone segment, even though the most important change was that of transforming the osteotomy of long bones from a static and definitive intervention into a biologic surgical act and the result modifiable based on the postoperative anatomical and clinical evaluation.
External fixation has made osteotomy a corrective therapy with reduced invasiveness due to the absence of extensive periosteal and muscular preparation and dissection, also allowing the gradual and atraumatic correction of neighboring tissues. The rapidity and the essentiality of the osteotomy have meant that the intervention falls into the category of "fast surgery" (Fast Surgery), to which, however, is the concept of slow correction (Slow Correction) allowed by the external fixator, which gives the fabrics time to adapt to changes.
Osteotomy and external fixation: indications
Osteotomies are indicated in the treatment of all axial and articular deformities of congenital and acquired origin. The goal can be therapeutic, if the intervention is the definitive treatment of the deformity, or propedeutic, when it facilitates or makes possible a future definitive surgery. The external fixation, instead, adapts itself to the characteristics of the osteotomy and of the deformity, without reducing the bone patrimony and interfering with any subsequent surgical interventions.
In Orthopedics, the most frequent use of joint osteotomy-external fixation is in the treatment of deformities in varus or valgus of the knee and in the diaphyseal deformities of the femur, of the tibia, of the humerus and of the forearm; in Traumatology, it is used for post-traumatic deformity outcomes of long bones. Other fields of application are the congenital and post-traumatic deformities of the back and forefoot.
Editor Karin Mosca