Evans osteotomy fixation?

[air bud]

How does everybody fixate their Evans? In training most of the people we just did a k-wire and then pull it out a few weeks later. I've done those mostly since I got out but finally got burned with dorsal displacement of the distal calcaneus. It's still fused. Then I have started doing mostly plates. Not sure how I feel about Staples. The plates I have done haven't had anybody with irritated peroneals and I know that was the big dogma about why not to use them.

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[PatchAdamsFan]

I use K-wire mostly in peds cases and pin the CCJ, haven't had displacement yet pulling at 4-6 weeks. Everyone else either no fixation about 60% of the time (works 100% of the time), and either a screw or flush staple if concerned for instability. Haven't used a plate since seeing shredded peroneals on hardware removal - but I'm sure plates are fine in general.

 

[air bud]

I use K-wire mostly in peds cases and pin the CCJ, haven't had displacement yet pulling at 4-6 weeks. Everyone else either no fixation about 60% of the time (works 100% of the time), and either a screw or flush staple if concerned for instability. Haven't used a plate since seeing shredded peroneals on hardware removal - but I'm sure plates are fine in general.

Interesting, have often wondered how widespread k-wire are use was. Have had more wound problems actually than displacement of the bone.

 

[Feli]

K wire unless medial cortex breaks... then double staple

 

[PatchAdamsFan]

Interesting, have often wondered how widespread k-wire are use was. Have had more wound problems actually than displacement of the bone.

Just don't lick the K-wire before putting the dressing on. To be serious, I place patients on 1 week prophylaxis abx if they leave the OR with any external hardware, no problems so far. Maybe I'm just creating superbugs, dunno.

 

[air bud]

K wire unless medial cortex breaks... then double staple

Does putting my saw bladw through count as " breaking"?

You worry about graft compression? This is one of the times when don't want a nitinol staple.

 

[AttackNME]

How does everybody fixate their Evans? In training most of the people we just did a k-wire and then pull it out a few weeks later. I've done those mostly since I got out but finally got burned with dorsal displacement of the distal calcaneus. It's still fused. Then I have started doing mostly plates. Not sure how I feel about Staples. The plates I have done haven't had anybody with irritated peroneals and I know that was the big dogma about why not to use them.

Did you overdissect the CCJ? Plates are good to maintain correction, unless you’re using porous titanium wedges, the bone grafts usually resorb a bit losing some correction

 

[Pronation]

Metal wedge, no fixation. Have not had any nonunions, displacement, or perianal irritation.

 

[toetransplant]

Metal wedge, no fixation. Have not had any nonunions, displacement, or perianal irritation.

I hope there is no perianal irritation. XD

 

[Sweatshirt]

We either use a tiny 2 hole locking plate or no fixation at all

 

[wakaflocka88]

Usually just throw a 2.7/3.5 positional screw across it. Or staple. Plate is too much work

 

[air bud]

There was a paper by didomenico showing a dual purpose screw. The inferior screw for the mcdo you make extra long and run through the Evans. There are threads crossing the entire way so you're not getting compression across it I always liked that idea but have never seen anybody doing it. Seems like a good way to keep costs down as well as get good fixation without compression and without tendon irritation.

 

[Pronation]

Slick fixation although I rarely find myself doing a double calc osteotomy.

 

[air bud]

Slick fixation although I rarely find myself doing a double calc osteotomy.

I do more of them than used to. Heavier people. Adjunct to Evans which is the workhorse.

 

[GreenHousePub]

I don't fixate them and use an allograft. Have not had problems.

Edit: Usually part of a double calc.

 

[Scrantonicity]

Metal wedge, no fixation. Have not had any nonunions, displacement, or perianal irritation.

Same, it just press fits in there so nicely…

 

[Pronation]

I hope there is no perianal irritation. XD

Oh there definitely is. Thankfully the peroneal irritation is absent.

 

[Pronation]

Same, it just press fits in there so nicely…

I’ve played around with this on cadavers. The wedge grips much better if you don’t try to impact it in where the pores get clogged up like a cheese grater effect as they grind along the bone. Basically try to keep the osteotomy gapped open enough with a pin distractor that the wedge just drops right in and then release the distractor to grip the wedge. Need a residency to confirm my stupid theory

 

[Weirdy]

I’ve played around with this on cadavers. The wedge grips much better if you don’t try to impact it in where the pores get clogged up like a cheese grater effect as they grind along the bone. Basically try to keep the osteotomy gapped open enough with a pin distractor that the wedge just drops right in and then release the distractor to grip the wedge. Need a residency to confirm my stupid theory

Will keep this in mind to test next chance we have.

 

[air bud]

I’ve played around with this on cadavers. The wedge grips much better if you don’t try to impact it in where the pores get clogged up like a cheese grater effect as they grind along the bone. Basically try to keep the osteotomy gapped open enough with a pin distractor that the wedge just drops right in and then release the distractor to grip the wedge. Need a residency to confirm my stupid theory

One thing I didn't like about the wedge is that unless a perfect cut it looks dumb on x-rays....bone just blends in.