Complications After Percutaneous Osteotomies of the Calcaneus

Abstract

Background: Open hindfoot surgery is associated with a relatively high rate of complications, including neurovascular injuries and wound healing problems compared with percutaneous techniques. However, there is a scarcity of literature describing the outcomes of these percutaneous techniques given their relatively recent adoption. The present study aims to assess the rate of postoperative complications for 3 commonly performed percutaneous calcaneal osteotomies. Methods: One hundred eighteen patients (unilateral feet) were treated with one of 3 common percutaneous calcaneal osteotomies. Sixty-five patients (55.1%) were treated with a medializing calcaneal osteotomy for hindfoot valgus, 32 patients with a Zadek osteotomy (27.1%) for insertional Achilles tendinopathy, and 21 patients (17.8%) with a modified Dwyer osteotomy for hindfoot varus. Fisher exact test was used to assess for associations between categorical variables. Results: The mean age was 46.2 years and there was a mean follow-up of 16.1 months. The overall rate of postoperative complications was 3.4% (n = 4), and no significant differences were found between the different osteotomy types. Complications included 2 cases (1.7%) of transient neuritis, 1 case of prolonged wound drainage (0.8%), and 1 nonunion (0.8%). None of the complications were associated with any recorded preoperative comorbidity. Discussion: In this series, we found that percutaneous calcaneal osteotomies are a safe alternative method for the treatment of conditions involving the hindfoot. The rate of postoperative complications may be less when compared to the reported rates of open hindfoot correction and should be considered in patients with a traditionally high risk of developing a postoperative complication. Level of Evidence: Level IV, retrospective analysis.

Minimally Invasive Approaches to Haglund’s Deformity and Insertional Achilles Tendinopathy: A Contemporary Review

“…When at least 3-6 months of conservative treatment strategies for HD and IAT have failed to provide adequate pain relief, surgical intervention should be considered. 12,47,49,53 Clinically, HD and IAT can present similarly; however, it is very important to specify between these pathologies when deciding on specific surgical treatment. Haglund syndrome is considered a spectrum of disease.…”

“…Therefore, this may be a preferred intervention for patients presenting with significant IAT or concomitant Achilles pathology. 12,49 ZO has been classically performed as an open procedure. However, the percutaneous approach has gained popularity to minimize wound complications while maintaining improved functional outcomes.…”

“…A plantar hinge of 5-8 mm should be preserved to minimize plantar cortex violation and fracture, which potentially increases risk of nonunion. 12,22,29,49 Although several osteotomy techniques have been described in the literature, we prefer the technique described by Kaplan et al 29 This technique includes percutaneous wires that act as a cutting guide for the osteotomy, as well as a system for cutting the dorsal wedge (Figure 6). In their technique, Kaplan et al describe the quadrants in 2 planes, coronal and sagittal.…”

Percutaneous Zadek Osteotomy for Insertional Achilles Tendinopathy and Haglund Deformity: A Technique Tip

“…A plantar hinge of 5-8 mm should be preserved to minimize plantar cortex violation and fracture, which potentially increases risk of nonunion. 2,3,5 At this point, a 5-mm incision is made in the safe zone to avoid the sural nerve, and blunt dissection with a mosquito is preformed down to the calcaneus. Next, either the 3 × 20mm or 3 × 30-mm Shannon burr is used to complete the dorsal closing wedge osteotomy along the marked out trajectory within the K-wire guides.…”

“…A plantar hinge of 5-8 mm should be preserved to minimize plantar cortex violation and fracture, which potentially increases risk of nonunion. 2,3,5…”