What is Corrective Osteotomy?
Corrective osteotomy is a surgical procedure to treat malunion or misalignment of a bone. The procedure involves cutting and reshaping of the deformed bone to restore normal alignment and function. A malunion refers to bone that has healed incorrectly after a fracture. A malunion fracture occurs when a large space between the displaced ends of the bone has been filled in by new bone. Malunion may lead to a bone being shorter than normal, bent, twisted, or rotated in a bad position.
Indications for Corrective Osteotomy
With fractures in the upper extremities, such as the forearm, wrist, and hand, a certain degree of angulation, or bend, is commonly noted when the bone heals. Your physician will determine if the position of the fracture will allow for functional use of the arm or hand after it heals. In many instances, when a fracture heals in a position that interferes with the use of the involved extremity, your surgeon will recommend corrective osteotomy surgery to correct it. Some examples of common upper extremity fractures that may lead to malunion include fractures of the wrists (distal radius), hand bones (metacarpals), and fingers or thumbs (phalanges).
Preparation for Corrective Osteotomy
In general, preparation for corrective osteotomy will involve the following steps:
- A history and physical exam by your doctor to obtain a history of your problem and perform an appropriate physical exam to find the exact area of concern.
- You will also need to undergo routine laboratory tests such as urinalysis and blood work and diagnostic imaging such as X-rays of the site in question. CT scan or an MRI may also be ordered if additional information is required of the area of concern. A preoperative plan for the procedure is prepared on the basis of the radiographs.
- You should disclose information about your previous and current illnesses, possible allergic reactions, your current medications and supplements, smoking history, etc.
- You may need to refrain from certain medications such as blood thinners and anti-inflammatories, or any supplements for a week or two prior to the procedure.
- Refrain from smoking or alcohol for a defined period before surgery and several weeks after, as it can hinder post-surgery healing or impact the surgery.
- You should not consume any solids or liquids at least 8 hours prior to the procedure.
- You should arrange for someone to drive you home after the surgery.
- A signed informed consent form is required from you after the procedure has been explained in detail.
Procedure for Corrective Osteotomy
Corrective osteotomy surgery is usually performed under general anesthesia. The goal of the surgery is to realign your upper extremity bone in a position that improves the function of your upper extremity. In general, the surgery involves the following steps:
- You will be placed on the procedure table with your upper extremity held in a position that provides the best operative angle for your surgeon.
- An incision is made over the site of concern in the upper extremity such as a wrist, forearm, or hand.
- The muscles and soft tissue structures are gently moved out of the way to access the treatment area.
- The area of deformity is exposed. Care is taken to prevent damage to the nerves.
- Your surgeon will re-break the deformed bone to realign the fracture.
- Depending upon the type of malunion, some of the bone may need to be trimmed to allow for proper orientation of the fractured ends.
- To keep the straightened bone in proper alignment, your surgeon may insert screws, plates, and/or pins.
- In addition, your surgeon may use bone grafts (bone tissue from elsewhere in your body) to aid in fracture healing.
- Finally, after confirming satisfactory repair, all surrounding tissues and structures are restored to their normal anatomic position.
- The incision is closed with sutures and sterile dressings are applied.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after corrective osteotomy will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely monitor your vital signs as you recover from the effects of anesthesia.
- After surgery, your arm will be placed in an assistive device such as a splint or a cast to facilitate healing and protect the repair.
- You may experience pain, swelling, and discomfort in the upper extremity. Pain and anti-inflammatory medications are provided as needed to address these.
- Antibiotics may also be prescribed to address the risk of surgery-related infection.
- You are advised to keep your upper extremity elevated as much as possible during the first month to reduce swelling and pain.
- Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
- You should refrain from strenuous activities and remain non-weight bearing (no use) with the operated arm until cleared by your surgeon. A gradual increase in activities over a period of time is recommended.
- An individualized physical therapy regimen will be designed to help strengthen your upper extremity muscles and optimize arm function once you are off assistive devices.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- You should be able to use the operated arm in a month or two after surgery. However, it may take at least 6 to 12 months for your upper extremity to regain its full strength.
- You may return to work in a month or two if your job is not too physically demanding. Those with physically demanding jobs will require a longer recovery period.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Corrective osteotomy is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Skin necrosis
- Arm pain, weakness, and stiffness
- Nerve and blood vessel injury
- Non-union (failure of the bones to heal)
- Inability to achieve complete correction
- Blood clots or deep vein thrombosis (DVT)