Comparison of an oblique single cut rotation osteotomy with a novel 3D computer-assisted oblique double cut alignment approach

Johannes G G Dobbe,Simon D Strackee,Peter Kloen,Geert J Streekstra

doi:10.1038/s41598-021-94141-4

Johannes G G Dobbe, Simon D Strackee + Show 2 more

Open Access

https://doi.org/10.1038/s41598-021-94141-4

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Abstract

An oblique double-cut rotation osteotomy (ODCRO) enables correcting a complex bone deformation by aligning, in 3D, the distal, middle and proximal bone segments with a target bone, without intersegmental gaps. We propose virtual preoperative planning of an ODCRO. To minimize a residual translation error, we use an optimization algorithm and optimize towards bone length, alignment in the transverse direction, or a balanced reconstruction. We compare the residual alignment error with an oblique single-cut rotation osteotomy using 15 complex bone deformations. The single-cut approach was not feasible in 5 cases, whereas the ODCRO procedure was feasible in all cases. The residual alignment error was smaller for the ODCRO than for the single-cut approach except for one case. In a subset for length reconstruction, the length error of 7.3–21.3 mm was restored to 0.0 mm in 4 of 5 cases, although at the cost of an increased transverse translation. The proposed method renders planning an ODCRO feasible and helps restoring bone alignment and lengthening better than an oblique single-cut rotation osteotomy. Awareness of the challenges and possibilities in preoperative planning of an ODCRO will be of value for future alignment surgery and for patients.

Highlights

Fracture management may lead to symptomatic malunion of bone segments, requiring surgical treatment
In an oblique doublecut rotation osteotomy (ODCRO) two osteotomies are performed as in a closing wedge osteotomy, but the wedge is reused as an autologous bone graft, in such way that alignment is achieved while the bone segments stay in contact
In this paper we propose an iterative method for optimal planning of an oblique double-cut rotation osteotomy, in which the intermediate bone segment is used as autologous bone graft

Summary

Introduction

Fracture management may lead to symptomatic malunion of bone segments, requiring surgical treatment. An OSCRO fails if a bone deformity extends over a particular length, for example due to trauma or disease[7]. In these cases the procedure may result in a local irregularity where the oblique osteotomy is placed. In cases where an OSCRO fails, a better treatment option may be an oblique doublecut rotation osteotomy (ODCRO). In an ODCRO two osteotomies are performed as in a closing wedge osteotomy, but the wedge is reused as an autologous bone graft, in such way that alignment is achieved while the bone segments stay in contact. In this paper we propose an iterative method for optimal planning of an oblique double-cut rotation osteotomy, in which the intermediate bone segment is used as autologous bone graft. We evaluate alignment by simulation and compare it with the achievements of an oblique single cut rotation osteotomy

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