Osteotomy Technique Research Articles

Bilateral sagittal split ramus osteotomy using a conventional osteotome-hammer and a magnetic mallet device: an in vitro comparison.

The conventional chisel osteotome technique (CCOT) and the magnetic mallet osteotome technique (MMOT) with a newly manufactured custom osteotome tip for the magnetic mallet device (MMD) were compared to determine whether magneto-dynamic osteotomies are as reliable for orthognathic surgery as the conventional method. A custom osteotome tip compatible with a magnetic mallet device was manufactured. Thirty-two fresh 1-year-old sheep hemi-mandibles were chosen for osteotomy procedures to achieve the most human-like results. Sagittal split ramus osteotomies were performed, and lingual fracture pattern (LFP), basis split pattern (BSS), duration of sagittal split osteotomy, and alveolar inferior nerve injury were investigated macroscopically. Six of the defined fracture schemes were observed out of the 27 lingual split patterns. After LFP and BSS evaluation, the unfavorable fracture counts for MMOT and CCOT are 3 and 4, respectively. The macroscopic nerve damage assessment for both groups is 2 for MMOT and 1 for CCOT. Although the average durations are similar in both groups, the difference between MMOT samples is closer. None above showed a significant difference. MMOT was evaluated as a reliable alternative to CCOT in bilateral sagittal split ramus osteotomy based on the lingual and basis split patterns, duration, and nerve damage findings.

Republication of "Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO): Short-term Prospective Case Series With a Novel Technique and Topic Review".

Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. IV, prospective case series.

Cubitus Varus Deformity Posttraumatic: A Case Report and Review of the Literature

Abstract The cubitus varus, frequently caused by a vicious callus, is the most common complication of the children’s supracondylar fractures, resulting from inadequate reduction or secondary displacement. We relate one case to analyze this complication. Our patient benefited from a step-cut osteotomy; the discussion was around different techniques of osteotomy to restore physiological valgus, including lateral closing-wedge, dome, three-dimensional, and step-cut osteotomies. The cubitus varus can be operated when the esthetic problem exceeds 15°, it associates a displacement in the three planes, whereas a correction in a single coronal plane can be accepted, the hyperextension must be treated for children over 10 years old. Humeral osteotomy is used to correct this deformity and to avoid later complications, such as ulnar nerve palsy, posterolateral rotatory instability, and secondary distal humeral fracture. The prevention and knowledge of the criteria for reduction supracondylar fractures should reduce the incidence of cubitus varus.

Poster 298: Establishment of a Novel Distance and Angle and Determining Their Relationship with the ACL

Poster 298: Establishment of a Novel Distance and Angle and Determining Their Relationship with the ACL

STRATEGY FOR SURGICAL CORRECTION OF THORACOLUMBAR KYPHOSIS CAUSED BY ANKYLOSING SPONDYLITIS

Various osteotomy techniques have been proposed to correct the kyphotic deformities caused by ankylosing spondylitis (AS). However, no technique could cater to all AS-related deformities well regarding the various mobility of calcified discs and the severity of deformities. Therefore, a thorough understanding of the strength and weaknesses of each method is essential. Then, a strategic approach could be formulated to select the most appropriate technique for a specific patient so as to have a correction operation with effectiveness, safety, and surgical simplicity. Among all preoperative examinations, the evaluation of disc mobility and the severity of kyphotic deformity is mandatory, which constitutes the base for the selection of osteotomy techniques. Since posterior column osteotomy (PCO) is the simplest technique, it should be used as much as possible. If up to three mobile discs are preserved, and the severity of the deformity is only moderate, e.g. the global thoracolumbar angle is less than 60[Formula: see text], contemporary poly-segmental PCO is selected. Staged PCO (SPCO), proposed by the authors, is the enhanced PCO with more excellent correction capability. If the disc mobility is not favorable enough, SPCO can be considered instead. PSO is the most versatile technique, capable of correcting all kinds of deformities regardless of disc mobility and severity of the kyphosis. This technique can be used in every case if surgical complexity is not a concern to the operator. Especially, PSO is the exclusive indication for those firmly ankylosed deformities without any mobile disc.

SHORT- TO MIDTERM RADIOGRAPHIC AND CLINICAL OUTCOMES OF ANTERIOR OPENING OSTEOTOMY WITH LAMINA SPARING IN POST-TRAUMATIC KYPHOSIS: A CASE SERIES

Purpose: Most spinal osteotomy procedures applied for spinal deformity and concomitant malalignment cases are associated with varied complications. This study evaluates the short- to midterm clinical and radiographic efficacy of the transpedicular anterior opening osteotomy technique. Methods: We retrospectively enrolled six patients who underwent transpedicular anterior opening osteotomy due to symptomatic rigid kyphotic deformity from May 2005 to 2016. During surgery, we created a new fracture line at the collapsed anterior vertebral body through bilateral pedicles, filled spaces with compacted bone grafts while preserving posterior elements, including lamina, and secured structure using posterior instrumentation. The kyphotic Cobb angle, Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) before and after surgery were measured and analyzed. Results: The mean preoperative kyphotic Cobb angle was 31.41 ± 4.77[Formula: see text] while the postoperative value was 15.75 ± 1.66[Formula: see text]. The mean correction angle was 15.55 ± 6.66[Formula: see text]. The mean follow-up duration was 50.17 ± 44.16 months. During the final follow-up, the mean kyphotic angle was not statistically different from the postoperative values. All patients with documented VAS Back and ODI had improved values postoperatively. Conclusions: Transpedicular anterior opening osteotomy with posterior element preservation improves clinical outcomes and is safe and effective in correcting regional, fixed kyphotic deformities.

Evaluation of the Efficiency of Double Osteotomy Technique for Residual Metatarsus Adductus Deformity

Evaluation of the Efficiency of Double Osteotomy Technique for Residual Metatarsus Adductus Deformity

Morphologic impact of four surgical techniques to correct excessive tibial plateau angle in dogs: A theoretical radiographic analysis.

To determine morphologic differences between four tibial osteotomy techniques used to correct excessive tibial plateau angle (eTPA). Retrospective radiographic analysis. Sixteen dogs (27 tibias) with eTPA. Virtual corrections of eTPA were performed on sagittal plane radiographs of canine tibia using four tibial osteotomy techniques and categorized into respective groups. Group A represented the center of rotation of angulation (CORA)-based leveling osteotomy (CBLO) and coplanar cranial closing wedge ostectomy (CCWO), Group B the tibial plateau leveling osteotomy (TPLO) and CCWO, Group C the modified CCWO (mCCWO), and Group D the proximal tibial neutral wedge osteotomy (PTNWO). Pre- and post-correction TPA, tibial length and mechanical cranial distal tibial angle (mCrDTA) were measured and compared. Mean TPA prior to correction was 42.67 ± 6.1°. Post-correction mean TPAs were 10.47 ± 2.1°, 6.77 ± 1.6°, 4.76 ± 1.5°, and 7.09 ± 1.3° for Groups A, B, C, and D, respectively. TPA correction accuracy in Groups A and D varied least from target TPAs. Tibial shortening was documented in Group B in contrast to other groups. The greatest mechanical axis shift was identified in Group A. Each technique achieved TPA < 14° despite having different effects on tibial morphology including alteration of tibial length, mechanical axis shift and variation in correctional accuracy. Despite all methods being able to correct eTPA, the choice of technique will affect morphology in unique ways and should be considered prior to surgery to consider the implications in a given patient.

Global network mapping research findings on orthognathic surgery and temporomandibular disorder

ObjectivesThe objective of this work is to assess the relationship between orthognathic surgery and temporomandibular disorders literature through a bibliometric analysis. MethodsA bibliographic search in line with the STROBE guidelines and the concepts of the Leiden Manifesto was performed on the Web of Science using the terms orthognathic surgery AND temporomandibular. A citation analysis and establishment of the more cited articles were performed. A graphical representation of the keywords was created with VOSviewer. ResultsA total of 810 articles were analyzed in this study. The research revealed a significant increase in publications on this topic, particularly in English language articles and a high H-index. The publications represented 55 nations, with the highest number of articles coming from the USA. The discussion of highly cited articles covered various aspects such as the relationship between orthognathic surgery and TMD, including condylar resorption or displacement, predisposing factors, dentoskeletal and occlusion patterns, anatomical factors, osteotomy techniques, condylar positioning techniques, and emerging technologies for improved TMJ stability. ConclusionThe analysis reveals an increasing research interest in this field, with a significant number of publications in English and a high citation rate per article, indicating the impact of the research. Various factors associated with TMD in orthognathic surgery are explored, including condylar alterations, predisposing factors, occlusion patterns, and surgical techniques. The study underscores the importance of thorough assessment, treatment, and monitoring of TMD in orthognathic surgery patients, while acknowledging the need for further research and consensus in management strategies.

Instantaneous center of rotation in the canine femorotibial joint: Ex vivo assessment of a tool to evaluate joint stabilization surgeries

Cranial cruciate ligament rupture is a common cause of femorotibial joint instability in the dog. Numerous techniques including several tibial osteotomies have been described for stabilization, but there is no current consensus on the best method. The instantaneous center of rotation (ICR) can aid investigations of pathological joint movement, but its use is problematic in the femorotibial joint due to combined rotation and translation during flexion and extension. Using fluoroscopic images from an earlier cadaveric study of canine joint stability, an interpolation method was used to create repeatable rotational steps across joint situations, followed by least squares approximation of the ICR. The ICR in intact joints was located mid-condyle but displaced significantly (P < 0.001) proximally following cranial cruciate ligament transection and medial meniscal release. Individual joints appear to respond differently to destabilization. Triple tibial osteotomy partially restored ICR location during early movement from flexion to extension. Joint instability significantly altered the proportions of rolling and gliding movement at the joint surface (P < 0.02), which triple tibial osteotomy partially improved. While triple tibial osteotomy restores joint stability ex vivo and clinically, normal biomechanics of the joint are not restored. The methods described here may prove useful for comparison of osteotomy techniques for stabilization of the cranial cruciate ligament deficient femorotibial joint in dogs.

Effectiveness and complications of transcrestal sinus floor elevation using the cushioned grind-out technique: A retrospective cohort study with up to 7 years of follow-up.

To evaluate the effectiveness and complications of the cushioned grind-out technique. The primary outcome was endo-sinus bone gain (ESBG), while secondary outcomes included the Schneiderian membrane perforation rate and mid- to long-term implant survival. In this retrospective study, we compared the cushioned grind-out technique with the classic osteotome technique, establishing statistical models to assess ESBG, membrane perforation rate and implant survival rate. A total of 259 patients and 340 implants were included. The mean ESBG was 5.31 mm for the cushioned grind-out group and 4.64 mm for the osteotome group. Multivariable regression analysis revealed that the cushioned grind-out technique significantly facilitated ESBG (p = .028). Nineteen preparation sites experienced membrane perforation, with rates of 5.5% and 6.4% for the cushioned grind-out and osteotome groups, respectively. However, the difference was not statistically significant (p = .920). Additionally, the cumulative survival rate of the implants for 7 years was 95.2% and 91.4%, respectively, with the surgical technique not significantly influencing the results. With 6 months to 7 years of post-prosthetic restoration review data, our findings show that the cushioned grind-out technique facilitates a higher ESBG, with no significant difference in membrane perforation or implant failure rate.

DOUBLE-BARREL DRILL SLEEVE: A SURGICAL INNOVATION FOR PERCUTANEOUS OSTEOTOMY

IntroductionOsteotomy is a key step in distraction osteogenesis. Various techniques of osteotomy have been described with its own benefits and pitfalls. Percutaneous osteotomy using multiple drill holes is one of the most widely used osteotomy techniques. It still remains a challenge however to keep the drill holes aligned prior to the osteotomy. Moreover, the efficacy of percutaneous irrigation practice to keep the temperature low during drilling with this technique is also debatable. With an aim to overcome these challenges, we are introducing a device called the Double Barrel Drill Sleeve (DBDS) to perform percutaneous osteotomies. We attempted to compare this method to the conventional multiple drill holes technique using laboratory experiments and clinical data.Materials &amp; MethodsDBDS has two adjacent parallel barrels that can fit 3.2 to 3.5 mm diameter drill bits. It has a guide member at the drilling end that can be inserted through a pre drilled hole at the near and far cortices of a bone. This provides a constant rotating point for drilling of holes through the barrels. An osteotomy simulation was performed to compare percutaneous drilling with DBDS vis-a-vis a conventional single drill sleeve (SDS) by qualified orthopaedic surgeons, mainly to assess the drilling patterns of both techniques. Percutaneous drilling was done on PVC pipes wrapped in thick sponge to simulate tubular bone with surrounding soft tissue. We also assessed the effect of indirect irrigation on temperature during drilling using the DBDS against a control group on a cadaveric bone model. Ultimately we reviewed our patients who had undergone osteotomy for distraction osteogenesis with DBDS and the conventional technique, and compared their outcomes.ResultsCompletion time for the osteotomy simulation in the DBDS group was significantly faster than the conventional drilling group; 74 seconds to 179 seconds. There was significantly less drilling deviation from the midpoint in the DBDS group as compared to the SDS group. Mean bone temperature during drilling with indirect irrigation using DBDS was significantly lower (32.6'C) compared to the control group (48.4'C). There was no significant difference in healing index between patients treated with DBDS and the conventional method. None of these patients developed non union.ConclusionsPercutaneous drilling with DBDS was quicker and more linear compared to the conventional method. Its double-barreled feature allows effective indirect irrigation during drilling. A comparable healing index in both of the techniques shows its clinical efficacy. These attributes make DBDS a usefull tool to overcome some of the pitfalls associated with the conventional multiple drill holes technique.

NEUTRAL WEDGE DISTAL FEMORAL OSTEOTOMY (NWDFO) FOR CORRECTION OF LARGE VALGUS AND VARUS DEFORMITIES: TECHNIQUE AND RESULTS

IntroductionAngular deformities of the distal femur can be corrected by opening, closing and neutral wedge techniques. Opening wedge (OW) and closing wedge (CW) are popular and well described in the literature. CW and OW techniques lead to leg length difference whereas the advantage of neutral wedge (NW) technique has several unique advantages. NW technique maintains limb length, wedge taken from the closing side is utilised on the opening side and since the angular correction is only half of the measured wedge on either side, translation of distal fragment is minimum. Leg lengths are not altered with this technique hence a useful technique in large deformities. We found no reports of clinical outcomes using NW technique. We present a technique of performing external fixator assisted NW correction of large valgus and varus deformities of distal femur and dual plating and discuss the results.Materials &amp; MethodsWe have treated 20 (22 limbs – 2 patients requiring staged bilateral corrections) patients for distal femoral varus and valgus deformities with CWDFO between 2019 and 2022. Out of these 4 patients (5 limbs) requiring large corrections of distal femoral angular deformities were treated with Neutral Wedge (NW) technique. 3 patients (four limbs) had distal femoral valgus deformity and one distal femoral varus deformity. Indication for NW technique is an angular deformity (varus or valgus of distal femur) requiring &gt; 12 mm opening/closing wedge correction. We approached the closing side first and marked out the half of the calculated wedge with K – wires in a uniplanar fashion. Then an external fixator with two Schanz screws is applied on the opposite side, inserting the distal screw parallel to the articular surface and the proximal screw 6–7 cm proximal to the first pin and at right angles to the femoral shaft mechanical axis. Then the measured wedge is removed and carefully saved. External fixator is now used to close the wedge and over correct, creating an appropriate opening wedge on the opposite side. A Tomofix (Depuoy Synthes) plate is applied on the closing side with two screws proximal to osteotomy and two distally (to be completed later). Next the osteotomy on the opposite side is exposed, the graft is inserted. mLDFA is measured under image intensifier to confirm satisfactory correction. Closing wedge side fixation is then completed followed by fixation of opposite side with a Tomofix or a locking plate.Results3 patients (4 limbs) had genu valgum due to constitutional causes and one was a case of distal femoral varus from a fracture. Preoperative mLDFA ranged from 70–75° and in one case of varus deformity it was 103°. We achieved satisfactory correction of mLDFA in (85–90°) in 4 limbs and one measured 91°. Femoral length was not altered. JLCA was not affected post correction. Patients were allowed to weight bear for transfers for the first six weeks and full weight bearing was allowed at six weeks with crutches until healing of osteotomy. All osteotomies healed at 16–18 weeks (average 16.8 weeks). Patients regained full range of movement. We routinely recommend removal of metal work to facilitate future knee replacement if one is needed. Follow up ranged from 4 months to 2 yrs. Irritation from metal work was noted in 2 patients and resolved after removing the plates at 9 months post-surgery.ConclusionsNWDFO is a good option for large corrections. We describe a technique that facilitates accurate correction of deformity in these complex cases. Osteotomy heals predictably with uniplanar osteotomy and dual plate fixation. Metal work might cause irritation like other osteotomy and plating techniques in this location.

A Cadaver-based Comparison of Sleeve-guided Implant-drill and Dynamic Navigation Osteotomy and Root-end Resections

IntroductionThis study compared the accuracy and efficiency of fully guided static and dynamic computer-assisted surgical navigation techniques for osteotomy and root-end resection (RER). MethodsFifty roots from cadaver heads were divided into two groups: fully guided static computer-assisted endodontic microsurgery (FG sCAEMS) and dynamic computer-assisted endodontic microsurgery (dCAEMS) (all, n = 25). Cone-beam computed tomography scans were taken pre and postoperatively. The osteotomy and RER were planned virtually in the preoperative cone-beam computed tomography scan and guided using 3D-printed surgical guides in the FG sCAEMS and 3D-dynamic navigation system in the dCAEMS. The 2D and 3D deviations and angular deflection were calculated. The osteotomy volume, resected root length, and resection angle were measured. The osteotomy and RER time and the number of procedural mishaps were recorded. ResultsFG sCAEMS was as accurate as dCAEMS, with no difference in the 2D and 3D deviation values or angular deflection (P > .05). The osteotomy and RER time were shortened using FG sCAEMS (P < .05). The FG sCAEMS showed a greater number of incomplete RERs than dCAEMS. Osteotomy volume, RER angle, and root length resected were similar in both groups (P > .05). FG sCAEMS and dCAEMS were feasible for osteotomy and RER. ConclusionsWithin the limitations of this cadaver-based study, FG sCAEMS was as accurate as dCAEMS. Both FG sCAEMS and dCAEMS were time-efficient for osteotomy and RER.

Effect of Different Crestal Sinus Lift Techniques for Implant Placement in the Posterior Maxilla of Deficient Height: A Randomized Clinical Trial

This study evaluated dental implant stability, vertical bone gain, bone density, and crestal bone loss using different crestal sinus lift techniques (osteotomy, Densah burs, and piezosurgery). A total of 21 patients were randomly divided into three groups: Group 1: patients were treated using a Densah drill crestal sinus lift, Group 2: patients were treated using a piezoelectric crestal sinus lift and Group 3: patients were treated using an osteotome crestal sinus lift. The patients in all three groups underwent bone grafting and implant placement. An Osstell device was used to determine the implant stability by recording the values of the implant stability quotient (ISQ). CBCT was performed before and 6 months after implant placement for radiographic evaluation and comparison among the groups. All dental implants were completely successful, and statistically significant differences from baseline to 6 months were noted in all groups (p &lt; 0.05). The Densah burs technique resulted in the best implant stability of all groups, while the osteotome technique demonstrated better vertical bone augmentation. However, the values for bone density and crestal bone loss showed no significant difference among all treated groups (p &gt; 0.05). All three techniques were successful for crestal sinus lifts with good clinical outcomes at a 6-month follow-up. The Densah group demonstrated better implant stability, shorter surgery time, and fewer complications; however, the vertical bone gain was greater with the osteotome technique.

Surgical correction of cubitus varus in children with a lateral closing-wedge osteotomy: a comparison between two different techniques.

The primary objective of the present study is to compare the radiographic outcomes and complications of two different techniques for lateral closing-wedge osteotomy in pediatric patients with cubitus varus. We retrospectively identified patients treated at five tertiary care institutions: 17 underwent the Kirschner-wire (KW) technique, and 15 patients were treated with the mini external fixator (MEF) technique. Demographic data, previous treatment, pre- and postoperative carrying angle (CA), complications and additional procedures were recorded. Radiographic evaluation included assessment of the humerus-elbow-wrist angle (HEW), and the lateral prominence index (LPI). Patients treated with both KW and MEF achieved significant improvements in clinical alignment (mean pre-op CA -16 ± 6.1 degrees to mean post-op 8.9 ± 5.3 degrees, P < 0.001). There were no differences in final radiographic alignment or radiographic union time; however, time to achieve full elbow motion was faster in the MEF group (13.6 versus 34.3 weeks, P = 0.4547). Two patients (11.8%) in the KW group experienced complications, including one superficial infection and one failed correction that required unplanned revision surgery. Eleven patients in the MEF group underwent a planned second surgical procedure for hardware removal. Both fixation techniques are effective at correcting cubitus varus in the pediatric population. The MEF technique may have the advantage of shorter recovery of elbow range of motion but may require sedation for hardware removal. The KW technique may present a slightly higher complication rate.

Concomitant valgus hip osteotomy in operative fixation of displaced proximal femoral neck fractures.

Total hip arthroplasty (THA) is considered the preferred treatment for displaced proximal femoral neck fractures. However, in many countries this option is economically unviable. To improve outcomes in financially disadvantaged populations, we studied the technique of concomitant valgus hip osteotomy and operative fixation (VOOF). This prospective serial study compares two treatment groups: VOOF versus operative fixation alone with cannulated compression screws (CCSs). In the first series, 98 hip fixation procedures were performed using CCS. After fluoroscopic reduction of the fracture, three CCSs were placed. In the second series, 105 VOOF procedures were performed using a closing wedge intertrochanteric osteotomy with a compression lag screw and lateral femoral plate. The alignment goal was to create a modified Pauwel's fracture angle of 30°. After fluoroscopic reduction of fracture, lag screw was placed to achieve the calculated correction angle, followed by inter-trochanteric osteotomy and placement of barrel plate. Patients were followed for a minimum of two years. Mean follow-up was 4.6 years (4.1 to 5.0) in the CCS group and 5.5 years (5.25 to 5.75) in the VOOF group. The mean Harris Hip Score at two-year follow-up was 83.85 in the CCS group versus 88.00 in the VOOF group (p < 0.001). At the latest follow-up, all-cause failure rate was 29.1% in the CCS group and 11.7% in the VOOF group (p = 0.003). The total cost of the VOOF technique was 7.2% of a THA, and total cost of the CCS technique was 6.3% of a THA. The VOOF technique decreased all-cause failure rate compared to CCS. The total cost of VOOF was 13.5% greater than CCS, but 92.8% less than a THA. Increased cost of VOOF was considered acceptable to all patients in this series. VOOF technique provides a reasonable alternative to THA in patients who cannot afford a THA procedure.

Ostéotomie tibiale biplanaire proximale pour la correction combinée du varus et des anomalies de la pente tibiale postérieure

Varus malalignment combined with an increased posterior tibial slope (PTS) in the ACL deficient knee is a frequent pathology, yet treatment for this condition remains challenging. The presented biplanar osteotomy technique allows to simultaneously address both components of malalignment in a single step. A detailed preoperative planning is best achieved by means of a digital planning software and constant intraoperative imaging is performed to verify the correction angle. A bony wedge is resected along with the extension osteotomy according to the preoperative planning and the medial-opening tibial osteotomy site is filled with bone allograft. Two bicortical lag screws are placed in anterior-posterior direction to secure the extension osteotomy, whereas a plate fixation is used for the medial-open osteotomy.

A long-term outcome (up to 29 years) of bilateral iliac wings “bayonet osteotomies” for closure of bladder exstrophy

BackgroundSeveral types of pelvic osteotomy techniques have been reported and employed by orthopedic surgeons to enhance the approximation of symphyseal diastasis in bladder exstrophy patients. However, there is limited evidence on a long-term follow-up to confirm which osteotomy techniques provide the most suitable and effective outcomes for correcting pelvic deformities. This study aimed to describe the surgical technique of bilateral iliac bayonet osteotomies for correcting pelvic bone without using fixation in bladder exstrophy and to report on the long-term clinical and radiographic outcomes following the bayonet osteotomies.MethodsWe retrospectively reviewed patients with bladder exstrophy who underwent bilateral iliac bayonet osteotomies with the closure of bladder exstrophy between 1993 and 2022. Clinical outcomes and radiographic pubic symphyseal diastasis measurements were evaluated. From a total of 28 operated cases, eleven were able to attend a special follow-up clinic or were interviewed by telephone by one of the authors with completed charts and recorded data.ResultsA total of 11 patients (9 female and 2 male) with an average age at operation of 9.14 ± 11.57 months. The average followed-up time was 14.67 ± 9.24 years (0.75–29), with the average modified Harris Hip score being 90.45 ± 1.21. All patients demonstrated decreased pubic symphyseal diastasis distance (2.05 ± 1.13 cm) compared to preoperative (4.58 ± 1.37 cm) without any evidence of nonunion. At the latest follow-up, the average foot progression angle was externally rotated 6.25° ± 4.79° with full hips ROM, and no patients reported abnormal gait, hip pain, limping, or leg length discrepancy.ConclusionsBilateral iliac wings bayonet osteotomies technique demonstrated a safe and successful pubic symphyseal diastasis closure with an improvement both clinically and radiographically. Moreover, it showed good long-term results and excellent patient’s reported outcome scores. Therefore, it would be another effective option for pelvic osteotomy in treating bladder exstrophy patients.

To compare and Evaluate Marginal Bone Loss Around Short and Long Implants Placed in Posterior Maxilla via Conventional Drills and Osteotomes.

PURPOSE-To calculate the marginal bone loss occuring around short and long implants placed using bone condensing osteotomes as well as using conventional drilling and to understand the viability of osteotome technique and short implants. MATERIALS AND METHODS- An in‑vivo study was undertaken to evaluate the crestal bone loss on mesial and distal aspect of short and long implants placed via osteotomes and conventional drills (group A,B,C,D 5 implants per group) using standardized intra‑oral periapical radiographs at baseline,3 months and 3 months post loading Statistical Analysis Used: Student’s unpaired t‑test. RESULTS- Long implant via drills and osteotomes were group A and B and their results were statistically significant different (p &lt; 0.004), short implant via drills and osteotomes were group C and D where better bone level was observed for short implant via osteotomes, when compared long implant via osteotome(group B) and short implant via osteotome The results show that bone level measurement at 3 months post loading were higher at mesial (0.52mm) and distal (1.06mm) positions for long implants compared to short implants placed via osteotome. The results were statistically significant (p&lt;0.05).CONCLUSION-Considering the limitations of implant placement in the posterior maxilla, osteotome and short implants are a non-invasive and predictable procedure for allowing implant placement and bypassing the invasive surgical, bone augmentation and graft procedures.