title: Screw size and insertion technique compared with removal rates for calcaneal displacement osteotomies.
abstract: BACKGROUND
  The calcaneal displacement osteotomy is frequently used by foot and ankle surgeons to correct hindfoot angular deformity. Headed compression screws are often used for this purpose, but a common complication is postoperative plantar heel pain from prominent hardware. We evaluated hardware removal rates after calcaneal displacement osteotomies and analyzed technical factors including screw size, position, and angle. We hypothesized that larger screws placed more plantarly would have been removed more frequently. We also believed that although 2 smaller screws cost more initially, when removal rates and cost are accounted for, savings would be demonstrated with this technique.
  
  
  METHODS
  We retrospectively collected data on type of fixation, cost of fixation, and frequency of removal. After exclusions we had 30 patients in our screw removal cohort and 119 in our screws retained cohort. A basic cost analysis and statistical analysis was performed.
  
  
  RESULTS
  The small screw group had a hardware removal rate of 9% (4/43) compared to 25% (26/104) of the larger screw group (P = .032). While the cost of 2 smaller screws is more than that of 1 larger screw, when the cost of removal and the rates of doing so are considered, the smaller screws resulted in substantial cost savings.
  
  
  CONCLUSIONS
  Technical considerations for the medial displacement calcaneal osteotomy, including the use of multiple smaller screws, provided for a lower rate of hardware removal and likely decreased long-term costs.
  
  
  METHODS
  Level III, comparative series.
authors.affiliation: Orthopedic Foot and Ankle Department, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Lucas
authors.affiliation: Front Range Orthopaedics, Colorado Springs, CO, USA.
authors.forename: G Alexander
authors.initials: GA
authors.lastname: Simpson
authors.affiliation: Orthopedic Foot and Ankle Center, Westerville, OH, USA.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Berlet
authors.affiliation: Orthopedic Foot and Ankle Center, Westerville, OH, USA ofacresearch@orthofootankle.com.
authors.forename: Terrence M
authors.initials: TM
authors.lastname: Philbin
authors.affiliation: St Joseph Health Center, Warren, OH, USA.
authors.forename: J Luke
authors.initials: JL
authors.lastname: Smith
mesh_terms: D000328:Adult; D001863:Bone Screws / Q000191:economics*; D002111:Calcaneus / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D015331:Cohort Studies; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D020878:Device Removal / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D013640:Tarsal Joints / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: calcaneal osteotomy; hardware removal; plantar heel pain; screw fixation