title: Medial Displacement Calcaneal Osteotomy: A Comparison of Screw Versus Locking Plate Fixation.
abstract: Locking plate fixation is becoming more popular for fixation of lower extremity osteotomies. The present study evaluated locking plate fixation compared with screw fixation in the medial displacement calcaneal osteotomy procedure, measuring the outcomes and rate of hardware removal. The procedure was performed on 30 patients, 31 times, with 17 undergoing single screw fixation and 14 undergoing locking plate fixation. The return to activity was 6.87 ± 1.43 months, including some patients for whom running was their main activity. No malunions, nonunions, displacements, or infections developed. In 3 patients (21.4%), the locking plate was removed compared with 1 patient (5.9%) who required screw removal. The difference was not significant (p = .30). No differences were found in their postoperative American Orthopaedic Foot and Ankle Scale scores (91.9 ± 7.7 with plates versus 94.4 ± 5.8 with screws; p = .36). The Roles and Maudsley scores were the same in the 2 groups preoperatively at 4.0 ± 0.0, with the postoperative scores improving to 1.50 ± 0.5 and 1.41 ± 0.5 for the plate and screw group, respectively (p = .62). No significant increase was seen for patients undergoing hardware removal, regardless of the adjunctive procedure used (i.e., flexor digitorum longus/Kidner, Lapidus or midfoot fusion, subtalar arthroereisis, and endoscopic gastrocnemius recession). The stage of posterior tibialis dysfunction had no significant difference in the postoperative scores. From the results of the present study, we have concluded that using a locking plate or a single screw for fixation of the medial displacement calcaneal osteotomy provides acceptable patient outcomes and that the differences in the rate of hardware removal were not statistically significant between the 2 groups.
authors.affiliation: Podiatrist, Department of Sports Medicine, Palo Alto Medical Foundation, Palo Alto, CA. Electronic address: heysax@aol.com.
authors.forename: Amol
authors.initials: A
authors.lastname: Saxena
authors.affiliation: Former Fellow, Palo Alto Medical Foundation, Palo Alto, CA.
authors.forename: Rajan
authors.initials: R
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D002111:Calcaneus / Q000601:surgery*; D005260:Female; D005413:Flatfoot / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000295:instrumentation*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: calcaneus; heel; internal fixation; posterior tibial tendon dysfunction; rearfoot valgus