Indications for Corrective Osteotomy after Malunited Fractures

Abstract

The indications for corrective osteotomy after malunited fractures of the lower extremity are based on a combination of clinical findings and theoretical aspects. It does not result from mechanical considerations alone. Of course, the various factors must be determined individually, but then they should be evaluated comparatively so that a final clinical decision can be made as to the most appropriate therapy. The discussion of special indications presumes that the general condition of the patient has been ascertained and the surgical risk is known. A posttraumatic deformity not only alters anatomy but also affects function in accordance with its location and extent. The secondary effects of an abnormal load-bearing alignment must be taken into account. The condition of the affected bony tissue, the neighboring joints, and functionally important soft-tissue structures have to be considered. Primary or secondary lesions influence not only the indication for osteotomy but also the selection of the operative procedure. The age and cooperativeness of the patient, the nature and severity of subjective complaints, professional and private living habits, and cosmetic aspects all must be included in the surgeon’s evaluation. In this chapter we shall examine the main factors influencing the selection of patients for corrective surgery, the variable importance of these factors, and the need to recognize priorities. The following factors are emphasized:

• 1. Unphysiologic mechanical loads on the joints.

• 2. The functional aspect.

• 3. Effects on capsuloligamentous structures of adjacent joints.

• 4. Morphologic condition of the bone, cartilage and soft tissues.

• 5. Subjective complaints.

• 6. Cosmetic effects.