title: Mid-Calcaneal Length After Evans Calcaneal Osteotomy: A Retrospective Comparison of Wedge Locking Plates and Tricortical Allograft Wedges.
abstract: Evans calcaneal osteotomy remains a cornerstone in the correction of the flexible flatfoot. Although multiple techniques have been used to maintain the length of the lateral column, a low profile wedge locking plate was recently introduced as an alternative to the traditional tricortical allograft wedge. We hypothesized that the wedge locking plate would better maintain the mid-calcaneal length compared with the tricortical allograft wedge. To test this hypothesis, after Evans osteotomy, the mid-calcaneal length was measured in the immediate postoperative period and again at 3 and 6 months. A total of 24 patients met the inclusion criteria. The mean patient age was 48.1 years (range 11 to 66). Of the 24 patients, 9 (37.5%) were treated with a tricortical allograft wedge and 15 (62.5%) with a wedge locking plate. At 3 months postoperatively, the mean decrease in mid-calcaneal length was similar for the tricortical allograft wedge group (1.3 ± 1.9 mm) and the wedge locking plate group (0.5 ± 0.9 mm, p = .275). At 6 months postoperatively, however, the mean decrease in mid-calcaneal length was greater for the tricortical allograft wedge group (2.8 ± 1.7 mm) than for the wedge locking plate group (0.6 ± 0.7 mm, p = .004). The 2 groups demonstrated a similar incidence of dorsally displaced distal calcaneal fragments throughout the study endpoint (p ≥ .052). These results suggest that the wedge locking plate better maintains the mid-calcaneal length over time compared with the tricortical allograft wedge.
authors.affiliation: Research Associate, Clinical Education and Research Department, Coordinated Health, Allentown, PA.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Protzman
authors.affiliation: Attending Physician, Avera Orthopedic Surgery Specialists, Aberdeen, SD.
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Wobst
authors.affiliation: Resident, Podiatric Residency Program, New York Methodist Hospital, Brooklyn, NY.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Storts
authors.affiliation: Fellow, Foot and Ankle Reconstruction, Coordinated Health, Bethlehem, PA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Mulhern
authors.affiliation: Attending Physician, Foot and Ankle Department, Coordinated Health, Bethlehem, PA.
authors.forename: Raymond E
authors.initials: RE
authors.lastname: McCarroll
authors.affiliation: Fellowship Director and Department Chair, Foot and Ankle Reconstruction, Foot and Ankle Department, Coordinated Health, Bethlehem, PA. Electronic address: drsbrigido@mac.com.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Brigido
mesh_terms: D000328:Adult; D064591:Allografts; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005413:Flatfoot / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000295:instrumentation* / Q000379:methods; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: calcaneus; displacement; flexible flatfoot; internal fixation; pes planovalgus