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    Cotton Osteotomy

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    bao
    This document discusses the cotton osteotomy procedure for correcting pes plano valgus foot structure. The cotton osteotomy involves making an opening dorsal wedge osteotomy of the medial cuneiform bone. This lengthens the medial column and plantarflexes the first ray. The procedure is indicated for pes plano valgus foot deformity, especially when used as an adjunct procedure. Technically, it involves planning the osteotomy site using fluoroscopy, making the dorsal wedge osteotomy cut, inserting a bone graft to hold the opening, and fixing it optionally with a plate or staple. Potential advantages are it is an easy procedure that provides good clinical correction of the arch. Risks include graft resorption,

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    Cotton Osteotomy

    Uploaded by

    bao
    191 views16 pages
    This document discusses the cotton osteotomy procedure for correcting pes plano valgus foot structure. The cotton osteotomy involves making an opening dorsal wedge osteotomy of the medial cuneiform bone. This lengthens the medial column and plantarflexes the first ray. The procedure is indicated for pes plano valgus foot deformity, especially when used as an adjunct procedure. Technically, it involves planning the osteotomy site using fluoroscopy, making the dorsal wedge osteotomy cut, inserting a bone graft to hold the opening, and fixing it optionally with a plate or staple. Potential advantages are it is an easy procedure that provides good clinical correction of the arch. Risks include graft resorption,

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    This document discusses the cotton osteotomy procedure for correcting pes plano valgus foot structure. The cotton osteotomy involves making an opening dorsal wedge osteotomy of the medial cuneiform bone. This lengthens the medial column and plantarflexes the first ray. The procedure is indicated for pes plano valgus foot deformity, especially when used as an adjunct procedure. Technically, it involves planning the osteotomy site using fluoroscopy, making the dorsal wedge osteotomy cut, inserting a bone graft to hold the opening, and fixing it optionally with a plate or staple. Potential advantages are it is an easy procedure that provides good clinical correction of the arch. Risks include graft resorption,

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    191 views16 pages

    Cotton Osteotomy

    Uploaded by

    bao
    This document discusses the cotton osteotomy procedure for correcting pes plano valgus foot structure. The cotton osteotomy involves making an opening dorsal wedge osteotomy of the medial cuneiform bone. This lengthens the medial column and plantarflexes the first ray. The procedure is indicated for pes plano valgus foot deformity, especially when used as an adjunct procedure. Technically, it involves planning the osteotomy site using fluoroscopy, making the dorsal wedge osteotomy cut, inserting a bone graft to hold the opening, and fixing it optionally with a plate or staple. Potential advantages are it is an easy procedure that provides good clinical correction of the arch. Risks include graft resorption,

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 16

    Cotton Osteotomy

    Ryan Pfannenstein, DPM, AACFAS


    Dept. of Foot and Ankle Surgery
    HealthPartners Medical Group / Regions Hospital
    Chief of Professional Services-HealthPartners Riverside Clinic
    Externship Director-Regions Hospital Reconstructive Foot and Ankle Surgical
    Residency Program
    Definition
    • Opening dorsally-
    based wedge
    osteotomy of the
    medial cuneiform
    – Lengthens the medial
    column
    – Plantarflexes the 1st
    ray
    Opening Dorsal Wedge Osteotomy
    of Medial Cuneiform
    • Indications
    – Pes plano valgus
    foot structure
    • Medial column
    procedure (usually
    adjunct)
    – Especially if no
    particular joint as
    apex
    » No plantar
    gapping
    • Hallux limitus with
    metatarsus primus
    elevatus
    Opening Dorsal Wedge Osteotomy
    of Medial Cuneiform
    • Technique
    – Planning
    • Fluoro-localize first met
    cuneiform, med cuneiform, n-c
    joints
    – Mark out with skin lines
    – Anatomic structures
    • EHL, Tib Ant, saph vein and
    nerve, DP
    Opening Dorsal Wedge Osteotomy
    of Medial Cuneiform
    • Technique
    – Incision
    • At least the entire med
    cuneiform
    • Just medial to EHL
    – Dissection
    • Skin and sub q
    • EHL sheath – retract EHL lat,
    retract tib ant
    • Incise to bone entire dorsal med
    cuneiform, can do a medial T
    • Elevate periosteum, may need
    to partially section
    intercuneiform ligaments
    Osteotomy
    – Parallel to 1st met-cuneiform
    joint
    – Middle of the medial
    cuneiform
    – Sagittal saw
    Osteotomy
    – Osteotome plantar
    cortex
    • Green stick or at min
    leave plantar
    periosteum intact
    – Pry open with
    osteotome or lamina
    spreader
    Bone Graft
    • Cadaver iliac crest tricortical
    – Try to select widest piece from bone bank
    • Usually 7 mm wedge
    • Draw out on graft (use one end to save in
    case it breaks, falls, does not fit)
    • Back table cut out
    – With sagittal saw (? Irrigation)
    Bone Graft
    Bone Graft
    • Slip in behind
    osteotome
    • Bone tamp until flush
    – Could remove the little
    prominence (low
    strength)
    Fixation
    • Not necessary
    • Could use a staple, spanning plate, screw
    – If concerned at crushing graft or loss of
    reduction
    – Layered closure, repair EHL sheath
    • Postop
    – 6 weeks strict NWB
    – 4 weeks graduated WB with crutches / walker
    in air cast
    Fixation
    Advantages
    • Easy dissection
    • Quick Procedure
    • Decreased chance of non-union vs. fusion
    • Better clinical correction of the arch
    – Treat the patient not the x-ray
    • Apex of deformity
    – Especially if there is a generalized midfoot
    collapse
    Complications
    • Graft resorption
    • Incomplete osteotomy – fx of plantar
    cuneiform
    – Leave saw blade in and fluoro
    • Cutting through plantarly leading to
    gapping and instability
    Complications
    Thank You

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