Modified Dwyer Osteotomy with Rotation and Reinsertion of Autograft Bone Wedge for Residual Heel Deformity Despite Previous Delayed Subtalar Joint Arthrodesis After Calcaneal Fracture |
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| Affiliation: | 1. Director, Foot and Ankle Surgery Residency Program, Regions Hospital/HealthPartners Institute for Education and Research, St Paul, MN;2. Chief Resident, Foot and Ankle Surgery, Regions Hospital/HealthPartners Institute for Education and Research, St Paul, MN;1. Specialist Registrar, West Midlands Deanery, Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, Shropshire, United Kingdom;2. Orthopaedic Consultant Surgeon, St Mary''s Hospital, London, United Kingdom;3. Orthopaedic Consultant Surgeon, St Thomas'' Hospital, London, United Kingdom;4. Orthopaedic Consultant Surgeon, Heatherwood and Wexham Park Hospitals, Berkshire, United Kingdom;5. Orthopaedic Consultant Surgeon, Dorset County Hospital, Dorset, United Kingdom;1. Professor, New York College of Podiatric Medicine, New York, NY;2. Resident, St. Barnabas Medical Center, Livingston, NJ;3. Student, New York College of Osteopathic Medicine, Old Westbury, NY;4. University of Delaware, Newark, DE;5. Practicing Physician, Medical Arts Radiology, Commack, NY;6. Attending Physician, Long Island Jewish Hospital, New Hyde Park, NY;1. Submitted while Fifth-Year Resident, Orthopaedics Residency, The University of Kansas School of Medicine–Wichita, Wichita, KS;2. Research Engineer and Teaching Associate, Via Christi Health, Orthopedic Research Institute, Wichita, KS;3. Associate Professor, Department of Orthopaedics Surgery, The University of Kansas School of Medicine–Wichita, Wichita, KS;4. Submitted while Fourth-Year Medical Student, University of Kansas School of Medicine–Wichita, Wichita, KS;5. Research Director and Professor, Via Christi Health, Orthopedic Research Institute, Wichita, KS;1. Fellowship Director, Department of Foot Ankle, Coordinated Health, Bethlehem, PA;2. Fellow, Department of Foot Ankle, Coordinated Health, Bethlehem, PA;3. Research Associate, Department of Clinical Education and Research, Coordinated Health, Bethlehem, PA;1. Department of Orthopaedic Surgery, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands;2. Sports Medicine Department, The Hague Medical Centre, Leidschendam, The Netherlands;3. Department of Radiology, Zuwe Hofpoort Hospital, Woerden, The Netherlands;4. Department of Orthopaedic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands;1. Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX;2. Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX |
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| Abstract: | Calcaneal fracture patterns vary widely, and many factors determine the type and timing of the treatment rendered. Severe calcaneus fractures involving joint damage, loss of heel height, and varus deformity of the tuberosity are ideally treated with open reduction and internal fixation to repair the joint surface and re-establish anatomic structure. This is not always possible owing to delayed presentation, soft tissue compromise, unrelated injuries, unstable medical condition, or lack of expertise by the treating physician. We present the case of a patient who had residual forefoot and rearfoot deformity despite undergoing delayed subtalar joint arthrodesis at an outside hospital 10 years before for a calcaneal fracture that was initially treated nonoperatively. At 4 years of follow-up after modified Dwyer calcaneal osteotomy with rotation and reinsertion of the autograft bone wedge and Cotton midfoot osteotomy, the postoperative gait was relatively normal, other than the expected lack of hindfoot mobility. The lateral column pain was resolved. The patient remained highly satisfied with the outcome at long-term follow-up of 48 months, with improved heel alignment, lack of a wide stance gait, a functional medial column, and a relatively normal gait. This case demonstrates the value of periarticular calcaneal osteotomies without the need to revise the subtalar joint arthrodesis for this challenging clinical situation. |
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| Keywords: | calcaneal fracture Dwyer osteotomy fusion subtalar joint arthrodesis |
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