Guidelines for the Execution of True Spherical Osteotomies Using a Modified Dome Blade Design

Abstract

Objectives The purpose of this study was to explore the trigonometric principles of the spherical osteotomy, establish guidelines for its application and test the guidelines on bone models using a new blade design. We propose a new rule of osteotomies incorporating the outlined geometric principles, and applicable to the use of spherical cuts in veterinary orthopaedic surgery.

Materials and Methods The trigonometric principles for the execution of neutral, closing and opening spherical osteotomies were explored in silico. A modification of the existing commercially available dome blade was designed and manufactured such that it facilitated the performance of spherical osteotomy with a minimized blade radius. A pilot study was performed whereby the modified dome blade was used to create spherical osteotomy in canine radial bone models. The surfaces of the osteotomy models were laser-scanned using a three-dimensional (3D) scanner; the resultant scans were imported into and analysed using a commercial 3D analysis software. The accuracy of osteotomy execution was measured as the distance between the targeted centre of osteotomy and the actual centre of osteotomy as found on the 3D scans.

Results By utilizing the geometric principles of spherical osteotomy, an accurate osteotomy position was achieved. The centre of the spherical cut performed on bone models was confirmed to be within 5% tolerance of the location as planned in silico demonstrating the accurate and relevant clinical application of geometric principles.

Clinical Significance The trigonometric guidelines for the execution of spherical osteotomy can be applied in a pre-clinical environment with accuracy. The new guidelines combined with the proposed new rule for spherical osteotomy utilizing the new blade design are translatable into clinical application, permitting the surgeon to accurately plan osteotomy application while mitigating the significant loss of bone-to-bone contact during correction of torsional deformities inherent in the principles of dome osteotomy use.

Keywords

spherical osteotomy - dome osteotomy - osteotomy blade - torsional deformities

Authors' Contributions

Christos Nikolaou contributed to conception of study, study design, acquisition of data and data analysis and interpretation. Cameron Black contributed to study design and data analysis and interpretation. Juan J. Ochoa contributed to conception of study and acquisition of data. Noel Fitzpatrick contributed to conception of the study, execution of the osteotomies, funding, guidance and documentation of clinical relevance. All authors drafted, revised and approved the submitted manuscript.

• References

• 1 Langley-Hobbs S. Disturbances of growth and bone development. In: Houlton J, Cook J, Innes J, Langley-Hobbs S. , eds. BSAVA Manual of Canine and Feline Musculoskeletal Disorders. Gloucester, UK: BSAVA; 2006: 50
• 2 Newton CD, Nunamaker DM, Dickinson CR. Surgical management of radial physeal growth disturbance in dogs. J Am Vet Med Assoc 1975; 167 (11) 1011-1018
• 3 Rudy RL. Corrective osteotomy for angular deformities. Vet Clin North Am 1971; 1 (03) 549-563
• 4 Franklin SP, Dover RK, Andrade N, Rosselli D. , M Clarke K. Correction of antebrachial angulation-rotation deformities in dogs with oblique plane inclined osteotomies. Vet Surg 2017; 46 (08) 1078-1085
• 5 Kim SY, Snowdon KA, DeCamp CE. Single oblique osteotomy for correction of antebrachial angular and torsional deformities in a dog. J Am Vet Med Assoc 2017; 251 (03) 333-339
• 6 Vandewater A, Olmstead ML. Premature closure of the distal radial physis in the dog. Vet Surg 1983; 12: 7-12
• 7 Balfour RJ, Boudrieau RJ, Gores BR. T-plate fixation of distal radial closing wedge osteotomies for treatment of angular limb deformities in 18 dogs. Vet Surg 2000; 29 (03) 207-217
• 8 MacDonald JM, Matthiesen D. Treatment of forelimb growth plate deformity in 11 dogs by radial dome osteotomy and external coaptation. Vet Surg 1991; 20 (06) 402-408
• 9 Paley D. Osteotomy Concepts and Frontal Plane Realignment. In: Paley D, Herzenberg JE. , eds. Principles of Deformity Correction. Berlin: Springer-Verlag; 2003: 99-154
• 10 Fox DB, Tomlinson JL, Cook JL, Breshears LM. Principles of uniapical and biapical radial deformity correction using dome osteotomies and the center of rotation of angulation methodology in dogs. Vet Surg 2006; 35 (01) 67-77
• 11 Fitzpatrick N, Nikolaou C, Ochoa J. , et al. True spherical dome osteotomy using a novel blade design in a dog with an antebrachial growth deformity: Planning and execution of technique. In: Proceedings of Veterinary Orthopedic Society 38th Annual Conference. Snowmass, Colorado; 2011: 22
• 12 Kwartowitz DM, Herrell SD, Galloway RL. Update: Toward image-guided robotic surgery: determining the intrinsic accuracy of the daVinci- robot. Int J CARS 2007; 1: 301-304
• 13 Nikolaou C, Fitzpatrick N, Isaza Saldariaga JF. , et al. The effect of configuration and radiographic positioning on measurements of deformity magnitude in a dog with a complex antebrachial growth deformity: comparison between radiographic and 3D computer modelling measurements. Proceedings of Veterinary Orthopedic Society 38th Annual Conference. Snowmass, Colorado; 2011: 34