title: Modified Dwyer osteotomy with rotation and reinsertion of autograft bone wedge for residual heel deformity despite previous delayed subtalar joint arthrodesis after calcaneal fracture.
abstract: Calcaneal fracture patterns vary widely, and many factors determine the type and timing of the treatment rendered. Severe calcaneus fractures involving joint damage, loss of heel height, and varus deformity of the tuberosity are ideally treated with open reduction and internal fixation to repair the joint surface and re-establish anatomic structure. This is not always possible owing to delayed presentation, soft tissue compromise, unrelated injuries, unstable medical condition, or lack of expertise by the treating physician. We present the case of a patient who had residual forefoot and rearfoot deformity despite undergoing delayed subtalar joint arthrodesis at an outside hospital 10 years before for a calcaneal fracture that was initially treated nonoperatively. At 4 years of follow-up after modified Dwyer calcaneal osteotomy with rotation and reinsertion of the autograft bone wedge and Cotton midfoot osteotomy, the postoperative gait was relatively normal, other than the expected lack of hindfoot mobility. The lateral column pain was resolved. The patient remained highly satisfied with the outcome at long-term follow-up of 48 months, with improved heel alignment, lack of a wide stance gait, a functional medial column, and a relatively normal gait. This case demonstrates the value of periarticular calcaneal osteotomies without the need to revise the subtalar joint arthrodesis for this challenging clinical situation.
authors.affiliation: Director, Foot and Ankle Surgery Residency Program, Regions Hospital/HealthPartners Institute for Education and Research, St Paul, MN.
authors.forename: Troy J
authors.initials: TJ
authors.lastname: Boffeli
authors.affiliation: Chief Resident, Foot and Ankle Surgery, Regions Hospital/HealthPartners Institute for Education and Research, St Paul, MN. Electronic address: kyle.w.abben@gmail.com.
authors.forename: Kyle W
authors.initials: KW
authors.lastname: Abben
mesh_terms: D001174:Arthrodesis / Q000009:adverse effects; D064592:Autografts; D016025:Bone Transplantation; D002111:Calcaneus / Q000293:injuries*; D005531:Foot Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D050723:Fractures, Bone / Q000150:complications* / Q000601:surgery*; D006365:Heel; D006801:Humans; D010027:Osteotomy / Q000379:methods*; D012399:Rotation; D013380:Subtalar Joint / Q000601:surgery*
keywords: Dwyer osteotomy; calcaneal fracture; fusion; subtalar joint arthrodesis