Comparing fixation used for calcaneal displacement osteotomies: a look at removal rates and cost.
BACKGROUND
The calcaneal displacement osteotomy is a procedure frequently used by foot and ankle surgeons for hindfoot angular deformity. Traditional techniques use compression screw fixation that can result in prominent hardware. While the results of the procedure are generally good, a common concern is the development of plantar heel pain related to prominent hardware. The primary purpose of this study is to retrospectively compare clinical outcomes of 2 fixation methods for the osteotomy. Secondarily a cost analysis will compare implant costs to hardware removal costs.


METHODS
Records were reviewed for patients who had undergone a calcaneal displacement osteotomy fixated with either lag screw or a locked lateral compression plate (LLCP). Neuropathy, previous ipsilateral calcaneus surgery, heel pad trauma, or incomplete radiographic follow-up were exclusionary.


RESULTS
Thirty-two patients (19.4%) required hardware removal from the screw fixation group compared to 1 (1.6%) of the LLCP group, which is significant (P < .05). Time to radiographic healing was not significantly different (P = .87). The screw fixation group required more follow-up visits over a longer period of time (P < .05). Implant cost was remarkably different with screw fixation costing on average $247.12, compared to the LLCP costing $1175.59. Although the LLCP cost was significantly higher, cost savings were identified when the cost of removal and removal rates were included.


CONCLUSIONS
This study demonstrates that this device provides adequate stabilization for healing in equivalent time to screw fixation. The LLCP required decreased rates of hardware removal with fewer postoperative visits over a shorter period of time. Significant savings were demonstrated in the LLCP group despite the higher implant cost.


METHODS
Therapeutic, Level III, Retrospective Comparative Study.
Doctor's Hospital, Columbus, Ohio (DEL)Orthopedic Foot and Ankle Center, Westerville, Ohio (GAS, TMP).
Douglas E
DE
Lucas
Doctor's Hospital, Columbus, Ohio (DEL)Orthopedic Foot and Ankle Center, Westerville, Ohio (GAS, TMP).
G Alex
GA
Simpson
Doctor's Hospital, Columbus, Ohio (DEL)Orthopedic Foot and Ankle Center, Westerville, Ohio (GAS, TMP) ofacresearch@orthofootankle.com.
Terrence M
TM
Philbin
D001860:Bone Plates / Q000191:economics*; D001863:Bone Screws / Q000191:economics*; D002111:Calcaneus / Q000601:surgery*; D017046:Cost Savings; D020878:Device Removal / Q000191:economics*; D006801:Humans; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D009820:Ohio; D010027:Osteotomy / Q000191:economics / Q000295:instrumentation*; D012189:Retrospective Studies
calcaneal displacement osteotomy; hindfoot deformity; locked lateral compression plate