Corrective osteotomies of the lower limb show a low intra- and perioperative complication rate-an analysis of 1003 patients.

Abstract

The purpose of corrective osteotomies in posttraumatic and congenital deformities is anatomic limb reconstruction and joint preservation. The aim of the present study was to analyse intra- and perioperative complications of osteotomies in the lower limb. One thousand and three unselected and prospectively registered osteotomies of the long bones of the lower limb, performed between 1995 and 2013, were analysed. In 435 women and 568 men (mean age 39.8 years), 478 correction osteotomies were performed femoral and 525 tibial; 696 osteotomies were performed using the oscillating saw, 42 using the Gigli saw and 265 using drill hole/chisel osteoclasis. A total of 869 deformities were corrected in the acute setting and 134 were corrected continuously via callotaxis. Seventeen (1.7%) major complications requiring revision surgeries were detected: 4 arterial injuries, 2 haematomas, 4 compartment syndromes and 7 deep wound infections. All vascular injuries 4 (0.7%) occurred in osteotomies around the knee (n = 563). Nineteen (1.9%) minor complications could be managed by conservative means: 3 (0.3%) deep vein thromboses and 16 (1.6%) superficial wound infections. No osteomyelitis, pulmonary embolism or death occurred. Gigli saw osteotomy was stained by a higher infection rate. In male patients (p = 0.02), posttraumatic deformities (ns) and continuous procedures (p = 0.025) have a higher risk of superficial infections. No further risks were detected for age, weight, smoking habit and anatomic level of surgery. Osteotomies around the knee show a very low complication rate. Less aggressive oscillating saws, saw blades and drills are recommended. Vascular injuries, compartment syndromes and deep infections are limb-threatening emergencies demanding fast and determined interventions. Prospective cohort study, Level III.