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Single Versus Double Pin Fixation of the Calcaneocuboid Joint During Calcaneal Lengthening Osteotomy for Pediatric
Kunhyung Bae1, Yoon Hae Kwak2, Michael Seungcheol Kang2
1Department of Orthopedic Surgery, Hanyang University Hospital, Hanyang University College of Medicine, Seoul.
Insights
Double-pin fixation after calcaneal lengthening osteotomy for pediatric flatfoot better maintained calcaneal pitch angle at two years. This method may improve midfoot-hindfoot alignment without affecting calcaneocuboid joint subluxation.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Foot and ankle surgery
Background:
- Calcaneocuboid (CC) joint subluxation is a known complication following calcaneal lengthening osteotomy for pediatric idiopathic flexible flatfoot.
- Temporary pin fixation is commonly used to prevent CC joint subluxation post-osteotomy.
Purpose of the Study:
- To compare the 2-year postoperative radiologic outcomes of single-pin versus double-pin fixation of the CC joint after calcaneal lengthening osteotomy.
- To evaluate the effect of pin fixation technique on CC joint subluxation and hindfoot alignment.
Main Methods:
- Retrospective review of 50 feet (30 patients) aged 9-15 years who underwent calcaneal lengthening osteotomy for idiopathic flexible flatfoot.
- Patients were divided into single-pin (14 feet) and double-pin (36 feet) fixation groups.
- Radiographic measurements, including CC joint subluxation index and five angles, were assessed preoperatively and at 3 months, 1 year, and 2 years postoperatively.
Main Results:
- At 2-year follow-up, the double-pin group showed a significantly higher calcaneal pitch angle (19.3±4.4 degrees) compared to the single-pin group (16.1±3.8 degrees; P=0.019).
- No significant differences were found in the CC joint subluxation index or other radiographic angles between the groups.
- Number of pins, preoperative talo-1st metatarsal angles, and patient age were independently associated with the 2-year calcaneal pitch angle.
Conclusions:
- While pin number did not influence CC joint subluxation, double-pin fixation was linked to superior maintenance of calcaneal pitch angle at 2 years.
- Double-pin fixation may offer better midfoot-hindfoot alignment post-calcaneal lengthening osteotomy, considering the 3D anatomy of the CC joint and calcaneal pitch characteristics.
Background:
Calcaneocuboid (CC) joint subluxation is a recognized complication after calcaneal lengthening osteotomy for pediatric idiopathic flexible flatfoot, and temporary pin fixation is often performed to prevent it. This study compared postoperative radiologic outcomes at 2 years of single- and double-pin fixation of the CC joint.
Methods:
We retrospectively reviewed 50 feet from 30 patients aged 9 to 15 years who underwent calcaneal lengthening osteotomy for idiopathic flexible flatfoot with a follow-up of at least 2 years. Fourteen feet (28%) underwent single-pin fixation, and 36 (72%) double-pin fixation. Five radiographic angles were measured, and the CC joint subluxation index was calculated preoperatively and at 3 months, 1 year, and 2 years postoperatively.
Results:
The mean age at surgery was 11.1±1.4 years, and there were no significant differences between the single-pin and double-pin groups. At postoperative 2 years, the calcaneal pitch angle was significantly higher in the double-pin group compared with the single-pin group (16.1±3.8 degrees vs. 19.3±4.4 degrees, P =0.019), whereas no significant differences were observed in the remaining radiographic angles or in the CC joint subluxation index ( P >0.05). Number of pins, preoperative anteroposterior and lateral talo-1 st metatarsal angles, and patient age were independently associated with calcaneal pitch angle after 2 years.
Conclusions:
Although the number of pins did not affect the CC joint subluxation index, double-pin fixation was associated with better maintenance of the calcaneal pitch angle at 2 years after calcaneal lengthening osteotomy for pediatric idiopathic flexible flatfoot. Considering the 3-dimensional anatomy of the CC joint and the characteristics of the calcaneal pitch angle, double-pin fixation may better maintain midfoot-hindfoot alignment after calcaneal lengthening osteotomy.
Levels Of Evidence:
Level III-retrospective comparative study.
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