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Modern medicine has reached a new level, and now surgical operations to eliminate a defect or bone disease no longer lead to such dangerous consequences than several decades ago.

One of the most popular procedures today is osteotomy.

This operation can significantly improve the life of a sick person, so specialists perform it without any fear.

What is the essence of the operation?

Osteotomy is a surgical intervention, the purpose of which is to eliminate a defect in the form of bone deformity, as well as to significantly improve the functions of the musculoskeletal system through an artificial fracture.

The operation at first glance looks rather scary, but according to its results, it is much easier for a person to stand if the procedures were carried out on their feet, or to independently perform simple actions and movements with their hands, in case of surgical intervention on the arm.

The operation is carried out in several ways: by incision of the skin or by making holes.

Fastening of broken bones is carried out using plates, screws, knitting needles and other devices.

Plaster bandages are practically not used, since this is fraught with bone displacement and repeated surgical intervention.

Varieties of intervention

As already mentioned above, the operation can be carried out by incision or punctures, as a result of which the osteotomy is divided into open and closed types.

The closed type of intervention is used extremely rarely.

Osteotomy, depending on the intended purpose, is divided into:

1. Corrective surgery- It is used due to an incorrectly fused bone after a fracture.
2. Derotational operation- is carried out in order to save a person from pathological rotation of the bone.
3. Lengthening or shortening of limbs– sometimes has a cosmetic connotation.
4. Surgery to improve support function.

Each type has its own characteristics and reasons for holding.

Sometimes bone fractures are cosmetic reasons. For example, in order to carry out a cosmetic surgery to lengthen the legs, an osteotomy is used - bones are artificially broken to further lengthen them.

Corrective surgery

The presented type of osteotomy is used every time when there is a significant deformation of the bones in the human body.

For example, this type surgical intervention applies in cases:

• improperly fused bone after a fracture;
• the presence of ankylosis of the joint in a vicious position;
• the presence of bone curvature due to rickets and in other situations.

Corrective osteotomy is sometimes performed by lengthening or shortening the bone, if such actions will lead to a positive result and significant relief to the person.

The operation is carried out in three ways:

1. Linear with bone graft- the bone is incised in order to align it through the introduction of a bone graft.
2. Wedge-shaped with removal of the bone wedge- a part is removed from the bone to align it.
3. corner– the bone is cut at an angle on both sides and is set in the correct position due to the necessary correction.

In most cases, corrective osteotomy is used after bone malunion due to a fracture. The operation is performed under general anesthesia and takes a long recovery.

Limb lengthening

Limb lengthening is the most common operation where an oblique osteotomy is used with skeletal traction applied to the distal end.

Such an operation can increase the operated bone by 2-7 cm.

The main condition is the selection of the correct size of the load. The presented method helps not only to "align the curved" bone, but also to significantly increase its length.

When using compression-distraction devices, it is possible to achieve the result of an increase in the length of the bone by almost 20 cm.

This method helps to increase the limb per day by 1 mm, while the mobility and function of the joints are preserved.

Derotational operation

It is often used after dislocations. If the plaster or tight bandage is applied incorrectly, a kind of reversal of the bone relative to the joint occurs.

Such a “contact” causes pain and can lead to dysfunction of the joints - a person cannot do simple actions with his hand, in case of damage to the lower extremities, the patient cannot move.

Derotational osteotomy involves cutting the bone in the transverse direction. Next, the central part of the bone is turned in the required direction at a certain angle of turn.

All participating bone fragments are fixed until recovery using a special metal structure. In some cases, suturing of the joint capsule and shortening or lengthening of the tendon is required.

If necessary, after diagnosing an x-ray, the angles of rotation can be adjusted. Recovery after such an operation can take several months.

Support function recovery

If the patient needs to restore support functions, osteotomy is performed on the hip joints. Here, a place is often created for the support of the hip bone.

The pelvic bones and the thigh itself are subjected to an incision. Such a surgical intervention is performed in the following cases:

Osteotomy for valgus and varus deformity of the lower leg

• the presence of congenital;
• when diagnosing false joints of the femoral neck;
• various deformations - or.

Several methods of bone dissection are also used here, depending on the goal of restoring the support function. The operation is performed exclusively under general anesthesia and requires several months of recovery.

The video clearly shows how a femoral osteotomy is performed:

Features of the operation and its consequences

An osteotomy is the cutting of a bone to improve a person's life.

But such improvements may not be noticed soon, especially since sometimes the operation, although it leads to the elimination of pain during the implementation of simple actions, but from the point of view of the cosmetic aspect, significant defects can be seen.

For example, the joints of the limbs will look asymmetrical, which can cause some discomfort to the operated person.

In addition, immediately after the operation, in most cases, long-term use of crutches (from one to three) months is required.

Despite the patient's uncomfortable position, the patient must take daily walks to restore the function of the operated bone.

The postoperative time is also accompanied by a course of physiotherapy, depending on the nature of the osteotomy. Full recovery can take up to a year.

Osteotomy can lead to certain complications, among which are revealed:

1. The beginning of the process of suppuration of the wound- a special role in the presented situations is played by the immunity of the operated patient.
2. Fragment Offset- occurs due to poor or incorrect fixation of them, which leads to a second operation.
3. Delayed bone healing- based on the individual characteristics of the human body.
4. Formed– impaired mobility of the operated bone and joint. A repeat operation is required.

In connection with the foregoing, it is better to perform osteotomy only after strengthening the immune system, as well as with a professional surgeon who will not allow displacement or suppuration of the wound.

The osteotomy has one serious disadvantage. If it is necessary to repeat the operation associated with the replacement of the joint, it will be much more difficult to carry out such an action if the bone has already been dissected.

But in some cases, osteotomy is the only true, possible and reliable solution to eliminate the existing disease.

Corrective osteotomy is a type of surgical treatment, during which the doctor performs the dissection of damaged bone structures. Often, a direct indication for the appointment of an intervention is osteoarthritis or another form of pathology. However, before specialists will carry out treatment by other methods. But in the absence of the desired effect, the operation will still be prescribed to the patient. Only in this way can he get rid of pain in the joint and restore his motor ability.

The duration of the intervention is within an hour, but sometimes the time can increase up to one and a half hours, depending on the complexity of the clinical case. As for anesthesia, the use of both local and general anesthesia is acceptable here, although the latter method is more often preferred.

After the doctor has introduced the selected type of anesthesia to the patient, the limb is treated with special antiseptic solutions, which avoids infection of the wound. Further, the doctor clearly determines which element of the bone, and in what volume he will excise it. This process is carried out under X-ray control. Or with the help of computer three-dimensional modeling.

When the order of work is determined, and the removal is performed, the diseased joint should receive maximum unloading from the injured cartilage tissue. Weight is more transferred to a healthy zone.

Also, corrective osteotomy is indicated for patients diagnosed with varus or valgus curvature of the thigh, rectus femoris after poliomyelitis. The area for the operation is the supracondylar region.

Kinds

As already mentioned, direct indications for the appointment of osteotomy are deformations of the bone structures, for example, if the patient has been diagnosed with joints in a strong position. If the doctor believes that the best therapeutic effect can be achieved during the operation by or shortening the limb, then it will be so.

There are three main types of corrective osteotomy:

1. Linear. The doctor makes an incision in the bone structures, after which a bone graft will be placed in them, which will lead to the alignment of the limbs.
2. wedge-shaped. To align the bone structures, a wedge-shaped excision of a certain area is performed.
3. Angular. Thanks to corrective manipulations and angle cuts of bone structures on both sides, the doctor can achieve the installation of the bones in the correct position.

Most often, such an operation is prescribed to patients who have ever received, and he has grown together incorrectly. In this case, the duration of the procedure will be maximum, and specialists also use general anesthesia. will also take a long time.

Indications

An osteotomy is an operation in which a bone is cut.

The main pathologies in which treatment is prescribed in this way are:

• deformities of bones of congenital and acquired type (if they have a shape that does not correspond to the rules of anatomy) located on the thigh, shoulder or lower leg;
• adhesions in the joints of the bone and fibrous type, which provokes a violation of motor activity and the development of ankylosis;
• , and its complications;
• other metabolic pathologies of the bones of the skeleton;
• accumulation of purulent exudate in tissues and organs.

Thanks to modern technologies in surgical medicine, at present, tissue dissection is performed not only with a scalpel, but also with the help of ultrasonic waves, radio waves and a laser.

After the operation is performed, the thigh and its components are fixed in the required position with the help of medical instruments, including: nails, plates, bone grafts, plaster bandages, traction.

Peculiarities

Corrective osteotomy is performed to restore or improve the functions of the musculoskeletal system. That is why it is most often done on the femur, which allows you to create a fulcrum in the proximal part. Depending on which particular area is injured, whether it is a congenital dislocation of the hip or in its neck, the procedure is done both on the bone itself and in the pelvic area.

If a patient is diagnosed with ankylosis, that is, he suffers from a sharp limitation of motor abilities in the hip joint, the operation is performed based on the individual characteristics of the deformity presented in a particular clinical case.

When the patient progresses to the second stage, or the disease was detected at the very beginning, that is, it is classified as coxarthrosis of the first degree, or pseudarthrosis of the femoral neck, McMurray intervertebral osteotomy is indicated.

In this case, with coxarthrosis of the first or second degree, the goal is to deeper immerse the femoral head into the acetabulum, and in the second case, the goal is to move the load that the joint receives when performing movements.

It should be understood that such complex operations may be associated with the risk of developing all sorts of complications. For example, a piece of bone may break off or suppuration will occur. But in the process of rehabilitation, there is a possibility of the formation of a false joint and slow fusion.

Rehabilitation

Corrective osteotomy has long been used by surgeons to treat pathologies of the hip joints. Therefore, there is a general plan of rehabilitation measures that the patient must follow. After the operation, the recovery time is from one to six months. It all depends on the complexity of the procedure itself and the age of the patient.

Recently, doctors have begun to practice only the use of special bone fixators, and they decided to refuse plaster bandages as much as possible. In some cases, the plaster is applied only a few days after the operation. However, if the procedure was complex, and many restorative actions were performed on a small area, then such a step is extremely necessary. The patient will have to wear a cast from several weeks to a month.

It is important to strictly adhere to medical recommendations during the rehabilitation process. And if the specialist said that it is necessary to undergo a course of physiotherapy, massage and exercise therapy, then they should not be neglected, because otherwise a false joint or may form.

You should also control your own. You don't have to eat junk food. The diet should be balanced and rich in fresh fruits and vegetables. This approach will help to compensate for the lack of vitamins, as well as prevent weight gain.

Corrective osteotomy is a high-tech operation that is used to correct deformities of the lower extremities. The technique gives especially good results with deforming arthrosis of the knee joint. Moreover, knee osteotomy is an effective alternative to arthroplasty! This surgery is well tolerated by patients, so the installation of an artificial joint can be delayed for many years. Ideal for people who are accustomed to an active lifestyle!

How is a corrective knee osteotomy performed?

The operation involves an artificial "fracture" of the lower leg (as shown in the figure) and the installation of a special plate. This allows you to change the axis of the leg and accordingly relieve pressure on the damaged part of the cartilage.

An x-ray examination is mandatory before the operation. With the help of digital radiography, special axial images of the injured lower limb are taken. On a computer, these pictures are “stitched” into one picture. Anatomical angles and axes are measured directly on it, and the angle of deformation is calculated.

Then proceed to the corrective osteotomy of the knee joint. This surgery is minimally invasive: it is performed through a small incision and only under X-ray control. The doctor will not do any fraud "by eye", which guarantees a successful outcome of the operation!

The tibia is partially crossed (in medical terms - osteotomy) and the deformity is corrected. Then the zone is fixed in the required position. It is important that modern fixatives do not require external immobilization (for example, plaster overlay).

Features of knee osteotomy:

• The duration of the operation is 50 minutes
• Stay in the clinic - 3-4 days
• Limb loading (e.g. driving a car) – after 6 weeks
• Sports activities (skiing, football, running) - after 10 months

The patient is 69 years old. The axial image shows a severe deformity of the knee joint. Same patient 3 months after osteotomy of the knee on the right limb. Preparing for an osteotomy on the left limb.

The patient is 29 years old. Deforming arthrosis of the left knee joint (developed against the background of an injury as a result of an accident 5 years ago). During this time he was treated conservatively. There was no positive effect. Before the operation, the axis of the limb was displaced inward, pain in the knee after physical exertion, swelling and limitation of joint mobility. In April 2012, an osteotomy of the left tibia was performed. The axis was corrected, the excess load on the femoral condyle was removed (pictured). Patient 2.5 months after surgery. The pain disappeared, the range of motion in the joint is full. Walks without additional means of support 8 weeks after surgical treatment.

The patient is 45 years old. Deforming arthrosis of the knee joint stage 2. For a long time I was worried about pain in the knee joint after exertion and at night. She was treated conservatively for a long time: sanatorium-and-spa treatment, intra-articular injections, anti-inflammatory drugs. The expected effect of the treatment was not. Operated by me in May 2012. Osteotomy of the tibia. At the control examination 2.5 months after the operation. There is no pain in the knee, he walks without a cane, the range of motion in the joint is full.

Patient 21 years old, rugby player. Chronic (2 years old) severe injury of the left knee: damage to the anterior cruciate ligament, cartilage defect of the medial femoral condyle (aseptic necrosis), damage to the medial meniscus. Disturbed by severe pain, there was instability in the knee. Pronounced deformity of the joint, defect of the femoral condyle. Completed corrective osteotomy, the anterior cruciate ligament was restored, the cartilage defect was corrected arthroscopically. Postoperative recovery is underway.

Osteotomy is an operation that is performed to cut the bone, which helps to cure certain diseases, both congenital and acquired. Speaking more generally, it is aimed at breaking the bone, after which measures are taken for its further, correct, fusion.

Main types

This method of surgical intervention is used under general anesthesia, and only on the bones of the lower or upper extremities. Today it is customary to distinguish between such types of osteotomy as:

1. Transverse.
2. Z - figurative (scarf-osteotomy)
3. oblique
4. Staircase.
5. Angular
6. Arcuate.
7. wedge-shaped.

The operation can be performed by closed or open method. In the first case, a small incision is made on the skin - no more than 2 cm long, after which the bone is blindly crossed with a chisel. Moreover, you need to work with a chisel very carefully, and at the very end, when the bones are connected to each other by a small bridge, just break them. This is done to avoid damage to vessels and nerves that may be located deeper than the level of the proposed fracture.

This type is used extremely rarely and in most cases an open osteotomy is used, where everything is done under the strict visual control of the surgeon.

Operation goals

Corrective osteotomy of the knee joint is a very effective operation that helps patients get rid of such a serious pathology as deforming arthrosis. At the same time, it is quite realistic to delay the installation of an artificial joint for a long time, which can be from 5 to 10 years, and sometimes longer.

The meaning of the procedure lies in the artificial fracture of the lower leg and its subsequent connection with plates. As a result, defects that previously prevented patients from leading an active lifestyle are corrected, and after the complete healing of such a fracture, they can again play football, ski, and engage in active sports. At the same time, pain and deformity of the joint disappear for a long time.

Corrective osteotomy can be used for almost any bone of the extremities, whether it be the lower leg, thigh, foot bones, and even fingers.

Contraindications and indications

There are some diseases when such surgical intervention is strictly contraindicated. These include:

1. Patello-femoral arthrosis of the 3rd degree.
2. Arthrosis of the contralateral joint.
3. Obesity.
4. extra-articular deformities.
5. Decreased bone regeneration.
6. The presence of an infectious process.

As for the indications, everything here is strictly individual and everything depends not only on the existing diseases, but also on the patient's age, body weight, and the presence of other pathologies.

For example, an osteotomy of the knee joint can be performed provided that the person is not yet 60 years old. If this age is exceeded, then the issue is resolved strictly individually. Also, the main indications for this surgical intervention include:

1. 2 degrees.
2. Absence of patellofemoral arthrosis.
3. The presence of valgus or varus no more than 15 degrees of curvature.
4. Isolated arthrosis of 2-3 degrees.
5. Full knee extension.
6. Intact cruciate ligaments.
7. Intact menisci of the knee joint.

Preparation and rehabilitation

Corrective osteotomy of the tibia or knee requires careful preparation from both the patient and the clinician.

The patient must undergo a complete examination, which includes blood and urine tests, a biochemical blood test, a blood sugar test, an X-ray examination of not only a possible site of an artificial fracture, but of the entire limb, a fluorographic examination of the lungs, a study for infections such as AIDS, syphilis, hepatitis.

As a rule, the operation is carried out according to plan, the patient can take all the necessary tests at the nearest clinic. On the appointed day, the patient is admitted to the hospital. The length of stay in the clinic after surgery is no more than 5 days. Outpatient rehabilitation can last 4 weeks or more. As for disability, this is decided strictly individually and usually this period is from 2 to 6 weeks. But here it all depends on the place of the osteotomy - foot, knee or thigh.

As for rehabilitation, electromuscular stimulators, magnetotherapy and lymphatic drainage can be used here. It is obligatory to wear an orthosis, which ensures the immobility of the operated bone.

Corrective osteotomy is a surgical operation aimed at correcting the deformity of a bone or joint by means of an artificial fracture. The knee, ankle, hip and shoulder joints are subject to treatment in this way. In severe cases, a corrective osteotomy of the tibia is performed for deforming arthrosis. The operation on the lower extremities is performed in order to restore the physiological position of the legs when walking. Operation on the upper limbs is needed to ensure self-care and professional activities.

Bone cutting at an angle for alignment

This treatment option is an alternative to arthroplasty and eliminates various deformities, restoring the function of the organ. Osteotomy can be performed on a child in case of improper union of the bone after a fracture or in the presence of congenital anomalies of the skeleton.

Corrective osteotomy is used to restore the function of the musculoskeletal system and eliminate the deformity of large joints. During the operation, a part of the bone is excised, it is given the correct shape, and reverse fixation is carried out with a special apparatus for osteosynthesis, as well as with the help of plates and screws. To align the upper and lower limbs, in some cases, they resort to shortening one of them. In this case, the excision of a certain bone fragment is carried out, followed by osteosynthesis.

After the operation, plaster bandages are applied. Sometimes they are replaced by knee pads with the ability to regulate the range of motion, which reduces the risk of contractures in the joints.

The need for corrective surgery arises in the following cases:

• improper union of supramalleolar fractures (corrective osteotomy in the shin area);
• valgization and (scarf technique shown);
• ankylosis of the hip joint;
• transferred poliomyelitis (correction of the subcondylar region);
• joint contracture;
• malunion of supracondylar fractures.

Indications for corrective osteotomy of the foot and the 1st metatarsal are impaired bone fusion and severe arthrosis.

Operation types

The following types of osteotomy are used:

• Z-shaped or scarf (with hallux valgus);
• wedge-shaped (correction of the axis of the phalanx of the finger);
• angular (excision of tissues at an angle to return the correct position);
• linear (alignment with a graft).

Osteotomy of the calcaneus with flat feet

Depending on the access, the following two types of operation are distinguished:

1. Option with the use of closed access. Allows you to correct the pathology through a 2 cm incision in the skin. The specialist works "blindly", so this treatment option requires increased caution and often leads to complications.
2. Open access option. This type is used more often. The operation is performed through an incision in the skin up to 12 cm, which allows you to completely open the necessary area of ​​​​the bone.

Quite often, the bones of the foot are corrected - the phalanx of the big right or left toe and the heel. This area has a large load during recovery after a fracture of the bones of the lower extremities, which is fraught with improper fusion. Surgical treatment is also prescribed for flat-valgus deformities with severe valgus, clubfoot, flat feet with complications.

The operation on the knee joints is carried out with the development of deforming arthrosis of a pronounced degree. Severe consequences of this disease lead to disability and a sharp decrease in the quality of life. To correct the violation, the installation of an implant is indicated; this treatment remains inaccessible for many patients due to the high cost. An alternative option is osteotomy of the tibia according to Ilizarov.

Surgery in the hip area is to change the configuration of the hip joint. In this case, surgeons strive to achieve a correspondence between the surfaces of the femoral head and the acetabulum. Treatment of HBS according to the Chiari method is carried out for (osteotomy with derotation variization) and adults.

Indications for carrying out

• congenital deformity of the lower and upper limbs in a child;
• a change in the position of the joint and a violation of the structure of the bone tissue due to past diseases (rickets, Paget's disease, osteoporosis);
• deformity with growth disorders (Blount's disease);
• post-traumatic deformity;
• arthrosis of the knee joint;
• instability of the ligamentous apparatus of the knee.

Contraindications

Surgical correction is contraindicated in the following situations:

• acute infectious diseases;
• chronic vascular diseases;
• disorders of the cardiovascular system and respiratory organs in the stage of decompensation;
• blood clotting disorder;
• advanced stage of patellofemoral arthrosis;
• violation of the regeneration of cartilaginous and bone structures;
• obesity (operation on hip joint, knee and foot).

Before the surgical treatment, the patient is informed about the possible consequences in the postoperative period.

After surgery, the following complications may develop:

• wound infection;
• displacement of fragments;
• the formation of a false joint;
• loss of skin sensitivity;
• rejection of implants;
• slow recovery.

As reviews show, temporary complications after surgery in the form of bumps, sensitivity disorders and the development of inflammation disappear without a trace when appropriate medication, physiotherapy and special exercises are prescribed. Timely and adequate treatment helps to reduce the rehabilitation period.

Features of the operation in children

Depending on the nature of the course of hip dysplasia in a child, the operation is performed on the femur or pelvic bone. The goal of treatment is to restore the physiological configuration of the joint. Before the osteotomy, the child is given an x-ray, magnetic resonance imaging, and laboratory tests. The operation is performed under general anesthesia. In terms of time, femoral osteotomy lasts from 2 to 5 hours, depending on the volume and complexity of the surgical intervention.

The technique was described by A.S. Hook in the book "Osteotomy of the pelvis in congenital dislocations of the hip." Also on this topic there are many articles by A.G. Shargorodsky and N.A. Semashko.

Indications for operations in childhood:

• previously untreated, advanced congenital subluxation;
• lack of effect from conservative therapy;
• avascular necrosis, a complication of Perthes disease;
• subluxation in children older than 8 years, which arose after an unsuccessful closed reduction;
• dysplasia with severe osteoarthritis;
• dislocations caused by spasticity or muscle weakness.

The child on the operating table does not feel anything, as he is in a state of deep sleep. After the operation, pain medications are prescribed. After surgery, a plaster cast is applied in the position of limb abduction.

The recovery period after the operation lasts from two to twelve months. After removing the cast, it is recommended to slowly and gradually increase the load on the operated leg.

Preparatory stage

Preparation for surgical treatment includes the following steps:

• a comprehensive examination is carried out with X-ray, magnetic resonance or computed tomography;
• some medications are canceled in a few days;
• The day before the operation, a special diet is prescribed and the time of the last meal is indicated.

Deformation of the femoral head, a consequence of dysplasia

When choosing a surgical technique and a scheme for managing a patient after surgery, it is necessary to take into account his state of health, the presence of concomitant diseases and contraindications to the use of certain drugs. The cost of corrective osteotomy starts from 35,000 rubles.

rehabilitation period

The patient is in the hospital under the supervision of medical staff for a week. During this period, the specialist monitors the general condition and changes in the operated area. The patient in the hospital is on a special diet. He must comply with the protective mode, which excludes any load on the limb, and use a knee brace.

The person is discharged from the hospital in a satisfactory condition and without complications. At the same time, he receives recommendations from the attending physician on drug treatment, which he must receive on an outpatient basis. A re-examination is carried out in a few weeks. As the recovery progresses, the doctor prescribes physiotherapy and exercise.

Rehabilitation can last from two to twelve months or more. During the entire recovery period, it is important to maintain muscle tone and normal blood circulation in the operated limb.

The rehabilitation period includes the following therapeutic measures:

• taking drugs to improve metabolic processes and blood circulation;
• physiotherapy, massage and therapeutic exercises;
• a diet enriched with vitamins and microelements;
• gradual increase in the load on the limb.

Patients are under medical supervision. If complications occur, the doctor prescribes a second laboratory and instrumental examination. After receiving the results, the treatment regimen can be changed.

Late Complications

Already in the first month of rehabilitation, various complications may appear. They are associated with incorrect treatment tactics, exacerbation of chronic diseases or the addition of other disorders (for example, due to damage to the peroneal nerve during surgery).

Symptoms indicating the development of complications:

• infection of the wound and suppuration of the skin;
• displacement of the fragment, the appearance of deformation, "bumps";
• severe pain in the operated area;
• limb numbness.

In the early postoperative period, several typical symptoms can be observed, which should not be disturbing. These include pain and swelling of the soft tissues in the operated area. If the unpleasant symptoms increase and the bone fragments are displaced, a thorough medical examination and a description of the patient's condition are necessary. If necessary, the doctor corrects the treatment regimen, and a second operation may be required.

Conclusion

Corrective osteotomy is a complex surgical treatment that is prescribed in cases where other methods are ineffective. Given the risk of disability, in advanced cases, experts recommend not postponing the operation. If the function of the limb is preserved, but there is an external defect, the doctor will select less traumatic methods of treatment.