Name of the Procedure:

Osteotomy; multiple, with realignment on intramedullary rod (e.g., Sofield type procedure)

Summary

An osteotomy is a surgical procedure that involves cutting and realigning bones. This specific procedure, often referred to as the Sofield type, involves multiple bone cuts and the insertion of an intramedullary rod to stabilize and straighten the bones.

Purpose

This procedure is typically performed to correct deformities in the bones, improve alignment, and enhance functionality. It is often used to address conditions like brittle bone disease or severe bone deformities that affect mobility and quality of life.

Indications

• Severe bone deformities, especially in the limbs
• Conditions like osteogenesis imperfecta (brittle bone disease)
• Abnormal bone growth or congenital deformities
• Failure of previous bone alignment surgeries

Preparation

• Fasting for at least 8 hours before the surgery
• Adjustments or cessation of certain medications as advised by the doctor
• Pre-surgical assessments such as X-rays, blood tests, and sometimes a bone scan
• Consent forms and a discussion of potential risks and outcomes with the surgical team

Procedure Description

1. Anesthesia: General anesthesia is administered to keep the patient unconscious and pain-free.
2. Incisions: Multiple small incisions are made over the areas of the bones that need to be realigned.
3. Bone Cuts and Realignment: The surgeon makes cuts in the bones (osteotomies) and repositions them to the correct alignment.
4. Rod Insertion: An intramedullary rod is placed inside the bone marrow cavity to hold the bones in the correct position and provide stability.
5. Closure: The incisions are closed with stitches or surgical staples.

Duration

The procedure typically takes 2-4 hours depending on the complexity and number of bones involved.

Setting

The surgery is performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technicians

Risks and Complications

• Infection at the surgical site
• Blood clots
• Nerve or blood vessel damage
• Failure to achieve proper alignment
• Rod displacement or breakage
• Delayed healing or non-union of bones

Benefits

• Improved bone alignment and functionality
• Enhanced mobility and ability to perform daily activities
• Reduced pain associated with bone deformities
• Long-term stability of the bones

Recovery

• Hospital stay for 2-7 days post-surgery
• Pain management with prescribed medications
• Physical therapy to aid in mobility and strength
• Avoiding weight-bearing activities for a specified period
• Follow-up appointments to monitor healing and rod placement

Alternatives

• Non-surgical management with braces or casts
• Single osteotomy without rod placement
• External fixation devices
• Each alternative has varying success rates and recovery times, and a detailed discussion with the orthopedic surgeon is necessary to choose the best option

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-surgery, there might be discomfort and pain, managed through medication. Physical therapy will likely be required to regain strength and mobility. Long-term follow-up will be necessary to ensure proper healing and functionality.