metaphyseal osteotomy

Dry end osteotomy for the treatment of knee valgus and knee varus. The oblique osteotomy was originally proposed by Rab. The osteotomy plane was at the distal end of the tibial tuberosity, proximal to the metaphyseal end of the posterior tibial plateau, and only the lower end of the tarsal plate. No need for strong internal fixation, and further orthopedics are performed by wedge-shaped plaster after surgery. Correction of the deformity is performed through two planes. Correction of rotational deformities requires horizontal osteotomy, while correction of internal and external valgus deformities requires osteotomy of the coronal plane, so the direction of oblique osteotomy is from front to back. The rotation of the osteotomy surface brings the two osteotomy surfaces into close contact, and the varus and rotational deformity can be corrected at the same time. If the osteotomy is more in the coronal plane, the correction of the inversion is more than the rotation; if the osteotomy is more in the horizontal plane, the correction of the rotational deformity is more than the inversion. According to Rab's experience, an upward 45° osteotomy provides adequate deformity correction for the vast majority of patients with Blount's disease. According to his report, varus deformity correction can be up to 44°, while internal rotation correction can be up to 30°. Treating diseases: rickets Indication Dry end osteotomy is available for: 1. Non-surgical treatment of knee and valgus deformities with persistent pain. 2. Although there is no clinical symptoms, the deformity is more serious, and the normal mechanical relationship of the knee joint is disordered. It is expected that knee osteoarthritis will occur. 3. The deformity is progressively aggravated. 4. Children over 5 years old with severe malformations, drug treatment has significantly controlled metabolic abnormalities. 5. Children with Blount's disease have poor treatment with orthopedic braces and lose their self-correction potential (over 5 years old). Contraindications Deficient vitamin D deficiency or osteomalacia is still active. Because of the soft bone, it is easy to cause recurrence of deformity when walking under osteotomy. Surgical procedure 1. Make a transverse incision in the lower pole of the tibial tuberosity. The periosteum is dissected in the Y-shape and dissected under the periosteum to the posterior aspect of the tibia (including the "goose" portion on the medial side of the ankle) for placement of the humerus plate or hook. If necessary, the periosteal incision can be extended distally to help the subperiosteal operation to protect the posterior soft tissue structure. 2. At 1 cm below the tibial tuberosity, punch a Sterling needle 45° backwards. Through fluoroscopy, it is ensured that the needle is located below the tarsal plate at the posterior aspect of the humerus and has its tip just past the posterior cortical bone of the tibia. The length of the stroke of the needle is measured and used to determine the depth of the bone knife or chainsaw osteotomy. Close to the distal side of the Sterling needle, the osteotomy is performed along the Sterling needle, and the osteotomy process is repeatedly monitored by fluoroscopy. When the osteotomy is nearly complete, the final osteotomy is performed from the anterior medial aspect of the tibia, as the subperiosteal is more fully exposed through the anterior medial aspect. 3. Make a small longitudinal incision in the middle of the humerus, 2 to 3 cm long. After the tibia was revealed, the humerus segment was removed 1 to 2 cm below the periosteum. 4. Push the humerus at the osteotomy before and after, and remove the periosteum at the osteotomy. On the outside of the tibial tuberosity, a bone hole is drilled through the osteotomy surface in the anterior-posterior direction. Centering on the osteotomy surface, the distal end of the osteotomy is everted and externally rotated, and if necessary, it can be overcorrected. Use a 3.5mm cortical screw or cancellous bone screw to fix the osteotomy surface through the pre-drilled bone hole, but the screw should not be tightened too tightly. 5. Incision of the fascia in the intermuscular compartment of the two incisions. 6. Relax the inflatable tourniquet, check the dorsal artery pulsation, completely stop bleeding in the incision, and place a negative pressure drainage tube. Subcutaneous tissue and skin are sutured with absorbable threads. Check the appearance of the lower extremities to determine the deformity correction. Because the single screw is not firmly fixed, it is very convenient to use wedge-shaped gypsum correction. Long leg casts are fixed and the knees are gently flexed. complication Common complications of osteotomy for correction of knee and valgus deformities include anterior compartment compartment syndrome, arterial embolism and radial nerve injury. Steel, Sandrow, and Stretching showed that the anterior tibial artery was pulled at the interosseous membrane while the varus correction (corrected valgus deformity) was performed by angiography in patients undergoing osteotomy, and in the valgus correction (correction of varus deformity) The anterior tibial artery is compressed here. Regardless of the cause of the complication, early diagnosis and return of the limb to the position before correction is critical. The paralysis of the common peroneal nerve is mainly manifested by loss of the back of the foot, active extension of the obstacle, without pain. Severe back pain and severe pain in flexion of the toe indicate arterial embolism or anterior compartment compartment syndrome. Principles of treatment: 1. For sacral nerve traction (usually in varus correction), the plaster should be removed immediately and the limb restored to the preoperative position. Remove all possible compression of the phrenic nerve, loosen the dressing and closely observe the changes in the condition. 2. For the anterior muscle compartment syndrome, the plaster should be removed, the limb should be restored to the preoperative position, and the dressing should be loosened. If there is no immediate recovery, it is crucial to perform a muscle compartment incision as soon as possible. 3. For anterior tibial artery embolization, the plaster should be removed and the limb restored to the preoperative position, loosened and bandaged, and closely observed.