Corrective derotating osteotomy with three-dimensional impression model: review of the topic based on a clinical case

• DOI: https://doi.org/10.22533/at.ed.1594662404075

• Palavras-chave: osteotomia correctiva, desrotadora, mal union, reconstrucción tridimensional

• Keywords: corrective osteotomy, derotational, mal union, 3D reconstruction

• Abstract:

  Corrective derotating osteotomies may be indicated for the correction of congenital pathologies at the level of the phalanges, or acquired due to trauma. In this article we will focus on traumatic deformities. Fractures of the fingers are the most common fractures. In most cases they are treated with conservative treatment, achieving good results, although in some cases surgical treatment using percutaneous or open osteosynthesis may be necessary. Despite strict controls, displacement of the fracture can occur with consequent poor union of the fracture focus, resulting in functional limitations of the hand. In these cases, treatment through corrective osteotomies may be feasible. In the case of rotational displacements at the level of proximal phalanx fractures (F1), on which we will focus, a digital crossing will occur. To correct this deformity, derotating osteotomies can be chosen at the F1 level or in the metacarpal (MTC). We will evaluate the use of computed tomography with three-dimensional printing for decision making and treatment planning. The objective of the present study is to update the topic through a review of different publications on corrective derotating osteotomies and also the use of 3D reconstruction for their treatment, based on a clinical case operated by the author. We carried out a bibliographic review on derotating osteotomies including the Medline databases (Pubmed interface), Scielo and Google Scholar. Material and methods: A narrative bibliographic review was carried out on derotating osteotomy at the phalanx and metacarpal level in traumatic malunions. The search was carried out including the Medline (Pubmed interface), Scielo and Google Scholar databases. The key words were used: “corrective osteotomy”, “derotational”, “mal union”, “3D reconstruction”. Discussion: Based on a clinical case, different possibilities regarding the topography of the osteotomy are evaluated; at the level of the original fracture, in the proximal phalanx or at the level of the corresponding MTC, the type of osteotomy; transverse or stepped, the type of fixation used, and the use of three-dimensional reconstruction. Results: a preference was seen for MTC osteotomy compared to phalanx osteotomy. Although for complex cases with a greater need for rotation, it is preferable to opt for an osteotomy in the proximal phalanx. No published articles were found that compare transverse derotating osteotomies with step osteotomies, although it has been proven that step osteotomies have a lower correction capacity. Stable osteosynthesis methods are preferred to achieve early rehabilitation and mobilization. There is only one article that uses three-dimensional reconstruction with excellent results.Conclusion: Derotating osteotomy is a simple technique used in cases of poor union of the proximal phalanx, with evident functional and aesthetic alteration with good results. In all cases, treatment must be individualized. The evaluation with computed tomography and previous 3D reconstruction allows a specific evaluation for each patient. It allows the surgery to be previously planned by evaluating the osteotomy site, the degrees of rotation necessary for adequate correction and the premolding of the plate, thus facilitating and shortening surgical time.