How modern technology is transforming complex osteotomy planning and execution
This chapter explores the evolution of corrective osteotomies from basic angular corrections to highly complex, multilevel and multiplanar realignments. The authors emphasise how digital workflows, 3-D imaging, patient-specific instrumentation (PSI) and additive manufacturing (3D-printing) now enable surgeons to plan and execute osteotomies with precision previously reserved for arthroplasty or high-end reconstructive procedures.
What key advanced techniques and workflows are described in this presentation
The workflow described includes:
- Acquisition of CT and EOS® imaging for full-limb alignment and bone geometry.
- Segmentation of bone models and virtual correction simulation in the planning software: angular, translational and rotational corrections are layered.
- Design of patient-specific cutting guides and drill sleeves printed in biocompatible polymer to translate the plan into the operating room with minimal guesswork.
- Intra-operative use of these guides to perform biplanar or multiplanar osteotomies with reduced exposure, followed by locking-plate or intramedullary fixation.
- Post-operative verification of alignment, hinge integrity and planning accuracy as part of the workflow.
What outcomes and lessons are reported for these complex cases
- The authors report that this advanced workflow has allowed the treatment of complex deformities (multiplanar, multilevel) that would have been very difficult with standard open techniques.
- They observe that while the technical planning time is higher, intra-operative uncertainty is lower, and overall surgical time and complication rates tend to decrease as the workflow matures.
- The chapter mentions that in a series of 49 corrective osteotomies planned with this method, two plate failures occurred and two pseudoarthroses were recorded, but all patients ultimately healed.
- They highlight that achieving an optimal correction still depends on surgeon judgement and intra-operative flexibility—even with advanced planning tools.
How these insights influence decision-making for surgeons and surgical teams
Surgeons managing complex limb deformities should consider the following:
- Pre-operative investment in imaging and digital planning is essential for success in complex osteotomies.
- Patient-specific instrumentation helps translate planning accuracy into surgical execution, but requires coordination with engineers, 3-D printing timelines and sterilisation logistics.
- Less invasive exposure is possible when guided by PSI, which may reduce soft-tissue trauma and expedite rehabilitation—but fixation and mechanical stability cannot be compromised.
- Even with advanced tools, robust fallback plans and intra-operative assessment remain critical, as complex corrections increase risk of unexpected events (hinge fracture, fixation failure, residual deformity).
- Surgical teams should have experience in both planning and execution; the learning curve for these workflows can be substantial.
What surgeons should keep in mind
- Complex osteotomies are increasingly feasible thanks to advanced digital planning, patient-matched instrumentation, and additive manufacturing.
- Precision in planning translates into better reproducibility of correction, but it does not replace careful surgical technique or good fixation.
- Patient selection remains critical—the benefits of advanced technique are most evident in multiplanar, multilevel deformities rather than simple single-plane cases.
- Surgical teams should integrate the planning workflow into their standard process, including imaging acquisition, segmentation, PSI design, intra-operative execution and post-operative verification.
