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Dorsum Surgery
Published in Suleyman Tas, Rhinoplasty in Practice, 2022
The surgery used to cut bone is known as an osteotomy. Performing this type of surgery smoothly and without creating additional fractures requires great skills, patience, and good equipment. Osteotomies used to be performed with hand saws in the 1900s; however, due to emerging bone defects through their use, they were then performed with a chisel, then with 4 mm guarded osteotomies, and then with 2 mm guarded osteotomies. Today, power tools facilitate this stage and two specific ones come to mind: ultrasonic devices and micromotors (Videos 3.1–3.2).
Surgery of the Foot
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Yaser Ghani, Simon Clint, Nicholas Cullen
The leg should be elevated for 72 hours until swelling has subsided. The leg is then placed in a non-weightbearing cast for a duration usually dictated by the soft tissue correction. The osteotomy usually heals within about 6 weeks.
Treatment of postlaminectomy kyphosis
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Christopher T. Martin, John M. Rhee
Multiple osteotomy options are available, including anterior column osteotomies, Smith-Petersen osteotomies (SPOs), and pedicle subtraction osteotomies (PSOs). A technical description of each is included in the subsequent sections. The choice of osteotomy is usually dictated by the location of ankylosis and the magnitude of correction needed. The amount of correction achieved with an osteotomy depends on a number of factors and will vary from case to case. Kim et al.11 reported that isolated SPOs with posterior fusion generated a mean angular correction of 10.1 degrees per osteotomy. Isolated anterior osteotomy with posterior fusion generated a mean correction of 17.1 degrees per osteotomy. Combined anterior osteotomy with posterior SPO generated a mean correction of 27.8 degrees per osteotomy. Isolated PSOs with posterior fusion generated a mean correction of 34.5 degrees per PSO. However, cervical PSO is more technically demanding than the other osteotomy types, and it may be associated with significant blood loss,12 with risk of neurologic complications as high as 23% in some series.13 Anterior osteotomy combined with posterior SPOs can provide equal correction with significantly less blood loss.11 However, in some cases of severe kyphosis, such as those with a chin-on-chest deformity, an anterior approach may be impossible. In those cases, a PSO may allow adequate correction of the deformity through an all-posterior approach.14
Patient-specific pre-operative simulation of the surgically assisted rapid maxillary expansion using finite element method and Latin hypercube sampling: workflow and first clinical results
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
L. Bonitz, A. Volf, S. Hassfeld, A. Pugachev, B. Ludwig, S. Chhatwani, A. Bicsák
The surgically assisted rapid maxillary expansion (SARME) was first described by E. C. Angell in 1860 (Angell 1860). Today, SARME and surgically assisted rapid palatal expansion (SARPE) are common, combined orthodontic and surgical procedures used to correct maxillary transverse deficiency in skeletally mature patients (de Gijt et al. 2017). The procedure consists of two steps. First, the maxilla is weakened by a bilateral osteotomy in the Le-Fort-I plane and pterygomaxillary suture and an opening in the mid-palatal suture is made (midline split). The extent of osteotomy depends on the patient’s age, bone quality, and anatomical conditions including the dental root position and neural structures (Koudstaal et al. 2005; Han et al. 2009; Rana et al. 2013). The state-of-the-art technique involves weakening the maxilla equally on both sides based on the experience of the surgeon. In this way, the extent of osteotomy can vary widely (Al-Ouf et al. 2010; Nada et al. 2012; Seeberger et al. 2015). In the second step, the maxilla is expanded using a distraction device, which is mounted on the palatine bone or the bicuspids of both the maxillary segments (Sander et al. 2006; Adolphs et al. 2014; Ulusoy and Dogan 2018).
Technical considerations for the management of segmental osseous defects with an internal bone transport nail
Published in Expert Review of Medical Devices, 2022
Lee M Zuckerman, John A Scolaro, Matthew P Gardner, Thomas Kern, Philipp Lanz, Stephen M. Quinnan, J. Tracy Watson, Jan Duedal Rölfing
The nail length and location of the corticotomy must be planned carefully. The location of the nail should allow for as many proximal and distal interlocking screws as possible to be placed for increased stability (Figure 2) [25]. The proximal threads of the interlocking screws are larger than the interlocking holes and templating will ensure these screws will obtain proper purchase and not impinge on the nail. If the transport will be over a long distance, the corticotomy should be made as close to the adjacent interlocking screws as possible without compromising the screw. Typically, this means leaving at least 3 mm of bone between the locking screw and the osteotomy. The optimal position of the intercalary screw holes and whether a screw exchange or nail recharge can take place or is necessary should be anticipated in order to complete the transport (Figure 3(a,b)). Although two intercalary screws will increase fixation into the transport segment, the use of only the proximal screw is necessary to facilitate a screw exchange across the slot bridge. If the corticotomy is placed too close to the intercalary screws a recharge may not be possible. When necessary, the intercalary screws can be placed through the regenerate for continued transport when the regenerate is mature enough (Figure 3(c)). If the regenerate is healed, a new osteotomy will have to be performed to continue transport. The nail can either be temporarily removed if this is necessary or the osteotomy can be performed around the nail, taking extreme care not to damage the nail.
Femoral and pelvic osteotomies for severe hip displacement in nonambulatory children with cerebral palsy: a prospective population-based study of 31 patients with 7 years’ follow-up
Published in Acta Orthopaedica, 2019
For the pelvic osteotomy, a modification of the incomplete transiliac Dega osteotomy was performed (Grudziak and Ward 2001) through a transverse anterior incision approximately 2 cm distal to the superior anterior iliac spine. The anterior part of the iliac apophysis was split and the inner and outer tables of the ilium were subperiosteally exposed. The osteotomy was performed with curved osteotomes. It started just above the anterior inferior iliac spine and proceeded posteriorly, keeping about 1.5 cm above the attachment of the joint capsule. The direction of the osteotomy was medially and inferiorly and ended just above the horizontal limb of the triradiate cartilage, leaving the posterior part of the cortex at the sciatic notch intact. A broad osteotome was used to lever open the osteotomy laterally and anteriorly. The bone graft from the femoral shortening was inserted in the open wedge (Figure 1).