Part 1: Corrective osteotomies for lower limb deformities

Abstract

The most common methods to realign a bone are an open or closing wedge osteotomy. Opening wedge osteotomies have the disadvantage of creating a defect between the bone ends that must fill in or be filled with bone graft. Closing wedge osteotomies have the disadvantage of needing greater exposure of the bone circumferentially in order to safely remove a wedge of bone. In the opening wedge osteotomy, undesired lengthening may be produced, while a closing wedge osteotomy may produce undesired shortening. The opening wedge osteotomy is adjustable but is relatively unstable due to minimal bone contact. The closing wedge osteotomy leaves little room for adjustment but produces a very stable situation with a large surface area of bone contact. Both opening and closing wedge osteotomies allow concomitant rotational and translational correction. The dome osteotomy shares the advantages of both osteotomies with few of their disadvantages. It is adjustable, has a large cross section area of bone contact, it is stable, and minimizes lengthening or shortening of the bone. The axis of correction of a dome osteotomy passes through the centre of the circle of which the dome is an arc. In three dimensions, the dome is a cylindrical cut. Therefore the axis of the dome osteotomy is the axis of the cylinder. To integrate the dome osteotomy into the geometry of deformity correction, one must match the axis of the dome with the axis of the planned correction. The dome osteotomy must follow