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International Congress of
the Italian Association of Companion
Animal Veterinarians

29 - 31 May, 2009
Rimini, Italy

Next Congress :

65th SCIVAC International Congress

May 28-30, 2010 - Rimini, Italy

Reprinted in IVIS with the permission of the Congress Organizers

Reprinted in IVIS with the permission of SCIVAC
62° Congresso Internazionale Multisala SCIVAC
Principles of corrective osteotomy
Michael P. Kowaleski
DVM, Dipl ACVS, Massachusetts, USA
Corrective osteotomy is performed to address a multiplicity
of disorders including joint incongruity, angular deformities
caused by growth deformity or fracture malunion, lengthening
of shortened bones, and to correct torsional abnormalities
caused by growth deformity or fracture malunion. In order to
optimize clinical outcome and mitigate complications, a num-
ber of principles must be followed.
1. Optimally time the procedure
Corrective osteotomy is an elective procedure, and as such
should be timed when it will be most beneficial for the patient.
Considerations include patient age, anesthetic considerations,
remaining growth potential, systemic disease, and affect of sur-
gical delay on regional joints or soft tissue structures.
2. Accurately define the condition
The condition requiring correction must be accurately
defined in order to determine the appropriate type and magni-
tude of correction. Most corrective osteotomy procedures have
very well defined indications; careful comparison of each indi-
vidual case to the indications for the various corrective proce-
dures will ensure consistent results.
In some cases, such as TPO, physical examination plays an
integral role in determining if the procedure is appropriate for
a given individual. In other cases, such as angular limb defor-
mity, radiographic examination is utilized to determine the
most appropriate type and magnitude of correction. In more
complex cases, a computed tomographic study may be utilized
to accurately define bony abnormalities, particularly torsional
abnormalities of the femur and tibia. In general accurate defi-
nition of the condition requires a minimum of two radiograph-
ic projections in orthogonal planes, and in some cases, com-
parison to the opposite normal limb.
3. Precisely plan the procedure
preoperatively
Preoperative planning of the actual surgical procedure as
well as the fixation will greatly facilitate precise and timely
surgical execution. The position and magnitude of correction
can be accurately determined from tracings of the radiograph-
ic images. Pre-contouring bone plates and pre-assembly of
external skeletal fixators also expedites and simplifies the sur-
gical procedure.
4. Perform the correction at the point
of maximal deformity
In the case of angular deformity, correction performed at the
point of maximal deformity will most accurately restore limb
alignment and maximize the cosmetic result. In general, per-
forming the two limbs of the osteotomy such that they are par-
allel to the respective joint surfaces will optimize the result.
Proceedings of the International SCIVAC Congress 2009
368
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5. Create a load-sharing construct when
practical
In order to maximize construct stability, minimize callus
formation and healing time, a load-sharing construct is pre-
ferred to buttress fixation. This is particularly true in diaphy-
seal corrections as opposed to metaphyseal corrections.
6. Perform an anatomic approach
The bone is approached through a standard anatomic
approach. In young animals, the thick periosteum can be
incised and elevated using a periosteal elevator. Adequate
exposure is essential to ensure that adjacent soft tissue struc-
tures can be protected during the osteotomy.
7. Exactly execute the osteotomy
A reciprocating bone saw is typically the instrument of
choice to perform the osteotomy. Alternatively, a gigli wire or
osteotome can be utilized. Since the bone is typically quite soft
in immature animals, the osteotomy can be defined by a series
of drill holes that are then connected with the thin osteotome to
minimize the risk of bone splintering.
8. Align the adjacent joints relative
to the diaphysis
Despite thorough preoperative planning, the accuracy of
correction must be verified intra-operatively. It is useful to
include the distal limb in the sterile field to ensure accurate
alignment is obtained. In some cases, inclusion of the opposite
normal limb in the sterile field for comparison is helpful.
9. Apply autogenous cancellous bone graft
Bone graft applied at the osteotomy site will expedite heal-
ing, thereby minimizing the risk for postoperative implant
related complications such as loosening or implant failure, as
well as delayed union.
10. Apply adequate fixation
In general, fixation appropriate for a diaphyseal fracture in a
similar patient is adequate for stabilization of the osteotomy.
11. Perform an anatomic closure
The wound should be anatomically closed in layers to opti-
mize postoperative limb function.
12. Obtain adequate follow up
Since these patients are frequently young, postoperative
complications such as implant loosening, continued growth
deformity, or joint related disorders might be encountered.
Appropriate follow up includes repeat physical and radi-
ographic examination until the osteotomy is healed and limb
function maximally improves.