Abstract
We present a new technique for corrective osteotomies in the lower limbs.
The method combines the advantages of both external and internal fixation as well as minimizing soft tissue disruption and scarring.
Material and Methods: Between January 2004 and August 2006, eleven osteotomies were performed on six patients. Mean age was 9.5 yrs. (6.4–15.9) Underlying pathology included cerebral palsy (3 pts), microcephaly (1), giant axonal neuropathy (1) and post traumatic growth disturbance (1). Osteotomies were performed in seven femurs (bilateral in 3 pts and unilateral in 1) and 4 tibias (2 pts bilaterally). Correction was in the transverse plane in four pts (4 femurs & 4 tibias), in the sagittal plane in one pt (2 femurs) and in multiple planes in one pt (1 femur).
Surgical Technique:
-
Insertion of Schanz screws perpendicular to the deformed segments
-
Osteotomy at planned level through small incision.
-
Correction of deformity and application of temporary external fixator.
-
Percutaneous insertion of submuscular extraperiosteal plate and fixation with locking screws.
-
Removal of external fixator.
Results: All limbs were corrected to within 3 degrees of planned correction.
Patients were allowed full ambulation. Casts were applied only if soft tissue releases were performed concomitantly. Ambulation as tolerated was initiated post operatively. There were no surgical complications. All osteotomies showed good callus formation within 6 weeks.
The plate was removed uneventfully from one patient.
Discussion: Multiple methods have been described for corrective osteotomies in long bones. They vary in the osteotomy level, degree of exposure, osteotomy technique and fixation method. The technique presented has the advantage of minimal violation of the periosteum and the surrounding musculature, inducing early bony union and good rehabilitation. The temporary external fixation enables accurate correction and intraoperative assessment.
Disadvantages include increased surgical time and radiation exposure – however these decrease with the learning curve and hardware improvements.
Correspondence should be addressed to: Orah Naor, IOA Secretary and Co-ordinator (email: ioanaor@netvision.net.il)
