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Multiple Drill-hole Osteotomy

Multiple Drill-hole Osteotomy of the Femur

This illustration shows an example of a multiple drill-hole osteotomy technique for a corticotomy in the distal femur (near the knee). A corticotomy is a bone-cutting technique that preserves the nearby bone vessels and periosteum (the tissue that covers the surface of bones). Several drill passes are made before an osteotome (a chisel-like bone-cutting tool) is used to complete the corticotomy.

Illustration of a multiple drill-hole osteotomy technique for a corticotomy in the distal femur (near the knee). The drill is passed several times before an osteotome is used to complete the corticotomy.

Focal Dome Osteotomy of the Supramalleolar Ankle

The focal dome osteotomy allows the surgeon to improve the patient’s bony alignment with a precise multiple drill-hole technique performed in an arc-like pattern. After the drill holes are made, an osteotome (a chisel-like bone-cutting tool) is used to complete the alignment. Internal or external fixation is added to maintain the correction. The following illustrations and fluoroscopic (intra-operative) images describe this procedure in the lower leg (tibia and fibula) near the ankle.

  • A. Deformity analysis: Analyze the angles of the lower tibia. (LDTA, Lateral distal tibial angle.)
  • B. Deformity analysis: Define the axes, apex, and magnitude of the deformity.
  • C1., C2. Focal dome osteotomy: Multiple drill holes are performed with a focal dome guide.
  • D. The fibular osteotomy is performed through a small incision below the level of the multiple drill holes in the tibia. The guide pins for screw placement are accurately positioned before osteotomy completion.

Illustrations and X-rays of a focal dome osteotomy technique for a supramalleolar ankle.

  • E. The osteotome allows for a low-energy fibular osteotomy, which improves the healing potential after correction. Multiple osteotomes are used to connect the tibial drill holes before a through and through osteotomy is completed.
  • F. Displacement of the tibia and fibula with an osteotome ensures the osteotomy is complete.
  • G1., G2. Acute alignment of proximal and distal axes is performed.
  • H1., H2. Internal fixation is utilized to maintain correction.