Osteotomy as a method of the treatment of lower limb deformities

Osteotomy is an operation in which a bone is cut, enabling a surgeon to reposition it. An osteotomy may be performed to lengthen or shorten a leg, to correct bowed or bent legs, or to reset a fracture. An osteotomy may be carried out in hip operations to alter the position of the thighbone and can be of help in the treatment of osteoarthritis of the hip. Total replacement of the hip joint with an artificial joint, however, is often more effective. (Copyright © 1998 World Book, Inc. All Rights Reserved. From The World Book Rush-Presbyterian St. Luke's Medical Center Medical Encyclopedia.)

In 1826 Dr.Barton had performed the first corrective osteotomy of a femur relatively to ankylosis of hip joint. In the end of the XIX century Drs. Goffe and Adolf Laurence worked out methods of the correction of varus and valgus deformities of lower limbs.

Osteotomy as a treatment method is in progress from the middle of the XIX century until the present days. And now the majority of orthopedists use it in their practice wide.

The indications for osteotomy are different congenital and acquired principally long bones deformities, fibrous and cystic joints ankylosises in incorrect positions, displastic, degenerative-dystrophic diseases of bones and joints.

There are different instruments, which are used for the bones division. There are chisels, osteotomes, thread saws (wire file saw by Gigli, wire file saw by Olivecrona), standard saws, last time some orthopedists use supersonic division. After the osteotomy bone fragments are fixated in the present or in new position due to the concrete goals.

Depending on the access to the bone osteotomies may be open and closed. Both types of osteotomies have imperfections and advantages. But practiced using of closed osteotomies can decrease the time of the following bones consolidation.

In the end of 1960-s famous Russian orthopedist Ilizarov had modified the standard method of osteotomy. Clinic investigations had induced him that it is necessary to save internal parts of the bone intact, including bone medulla, intraosseous blood vessels. Minimal operative traumatization of the bone and soft tissues optimizes biological conditions, which are necessary for the genesis of the new bone.

Ilizarov's modification of osteotomy includes the cut of only cortical layer of the bone with the maximal saving of periosteum and bone medulla. That's why it has taken the name corticotomy. Osteotomies can have different form and cut direction that is caused by the treatment goals.

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