evans calcaneal osteotomy
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TIPS, QUIPS, AND PEARLS
"Tips, Quips, and Pearls" is a special section in The Journal of Foot & Ankle Surgery which is devoted to the sharingof ideas to make the practice offoot and ankle surgery easier. We invite our readers to share ideas with us in the form ofspecial tips regarding diagnostic or surgical procedures, new devices or modifications of devices for making a surgicalprocedure a little bit easier, or virtually any other "pearl" that the reader believes will assist the foot and ankle surgeonin providing better care. Please address your tips to: Lowell Scott Weil, DPM, Editor-in-ChieJ, The Journal of Foot &Ankle Surgery, 1455 Golf Road, Des Plaines, 1L 60016; Fax: 847-729-0099; E-mail: [email protected]
Evans Calcaneal Osteotomy
Arnol Saxena, DPM
My retrospective review of approximately 20 cases overthe past few years seems to reveal that for every 1 mmof bone inserted into the lateral calcaneus, there is 1° ofangular correction in the transverse plane of the forefoot torearfoot angle (see Figs. 1 and 2). Since the upper limit of
Address correspondence to: Amol Saxena, DPM, Department ofSports Medicine, Palo Alto Medical Foundation, 795 EL Camino Real,Palo Alto, CA 94301; e-mail: [email protected] Journal of Foot & Ankle Surgery 1067-2516/00/3902-0136$4.00/0Copyright © 2000 by the American College of Foot and Ankle Surgeons
the wedge seems to be 15 mm, one may wish to considerother adjunctive procedures to get additional correction.
If one places the bone graft with the widest portionslightly more dorsal, one can increase the calcaneal inclination angle. I generally use tricortical (iliac crest) autograft or allograft or a calcaneal cross-section allograftavailable from MTF.1 Both of these techniques minimize
I Musculoskeletal Transplant Foundation, Edison, NJ. 125 May St.STE.300 Edison, NJ 08837; 800-946-9008.
FIGURE 1 A, Preop lateral radiograph showing calcaneal inclination angle of 12°. B, Preop AP radiograph showing forefoot adbuctionof 10°.
136 THE JOURNAL OF FOOT & ANKLE SURGERY
FIGURE 2 A, Postop lateral radiograph after a 13-mm autograft (iliac crest); note graft is wider dorsally and calcaneal inclination is now25°. B, Postop AP radiograph shows forefoot adduction is now 3° (abduction is reduced by 13°).
collapsing of the margins of the graft (and loss of correction).
Furthermore, to accurately assess how wide the lateralportion of the bone graft needs to be, I have modifieda lamina spreader without teeth, so that the ratchet iscalibrated in millimeters (Fig. 3). This instrument willbe available from KMedic2 this spring. I have foundthis saves at least 20 minutes in surgery time as graftpreparation is faster. This instrument is helpful for manytypes of procedures to accurately assess the amount ofbone graft needed such as for fusions (i.e., bone blocksubtalar and Lapidus) and nonunions.
Finally, to fixate the bone graft, I have found usingabsorbable rods or allograft bone pins to skewer the graftto be reliable. Hardware does not need to be removed,and I have not had displacement to a graft fixated in thismanner.
FIGURE 3 Modified retractor inserted in calcaneal osteotomy sitewith calibrated ratchet indicating how much graft can be inserted.
2 KMedic, Inc., Northvale, NJ.
VOLUME 39, NUMBER 2, MARCH/APRIL 2000 137