Special Diagnosis and Preoperative Planning of Corrective Osteotomies

Abstract

With modern techniques of internal fixation [9], we are able to perform almost any corrective osteotomy of bone with a high degree of precision. But surgical correction of the axial alignment of a leg must be preceded by meticulous planning, because postoperative corrections are no longer possible after stable internal fixation has been applied. Preoperative planning of this type must be predicated on sound, reproducible morphologic data, i.e., on the actual morphology of the leg skeleton under conditions of functional loading. The external, clinical appearance of a leg can provide only a hint of the osseous deformities that exist and thus of the correction that is required. A thick soft-tissue envelope can be highly deceptive, and clinical measurements of angles or of intercondylar and intermalleolar distances often give an incomplete or misleading picture of actual limb alignment. A realistic image of the leg skeleton in the frontal plane (Fig. 1) can be obtained only by means of a long Weight-bearing roentgenogram [11–16,20].