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A Simplified Method for Talocalcaneal Coalition Excision
Aaron Lam1, Rusty Hartman2, Kelsie M Coe3
1Baylor Scott and White Orthopedic Associates of Dallas.
Background:
Talocalcaneal (TC) coalitions are a common cause of hindfoot pain in adolescents. Resection is effective when the posterior facet is preserved but can be technically demanding, with risk of incomplete resection and prolonged operative time. This study describes a simplified technique for TC coalition excision and compares its outcomes with traditional methods.
Methods:
A retrospective review was performed of patients undergoing isolated TC coalition excision with autogenous fat graft interposition at a single pediatric institution (2001 to 2025). Patients with prior surgery, neuromuscular or syndromic conditions, or concomitant procedures were excluded. Forty-eight patients (54 feet) met the inclusion criteria: 39 feet underwent traditional excision, and 15 feet underwent a simplified technique using converging Kirschner wires to guide resection. Outcomes included tourniquet time, anesthesia time, procedural cost, and perioperative complications. Costs were estimated using institutional per-minute operating room rates. Statistical significance was set at P<0.05.
Results:
There were no differences between groups in age, sex, body mass index, or prevalence of flatfoot deformity. The traditional group had a higher proportion of osseous coalitions (51.3% vs. 13.3%, P=0.04). Tourniquet time (93.4± 20.5 vs. 47.5± 9.9 min, P<0.0001), total anesthesia time (118.6±30.9 vs. 58.9±14.2, P<0.0001), direct cost ($1987 vs. $986, P<0.0001), and total cost ($5819 vs. $2887, P<0.0001) were all significantly lower in the simplified method group. No perioperative complications occurred in either group. At a mean follow-up of 2.1 years (range: 0.10 to 8.2 y), there were no differences in complications or secondary procedures.
Conclusion:
The simplified technique for TC coalition excision using converging Kirschner wires is associated with reduced operative time and cost without increased complications. This method provides a reproducible and efficient alternative to traditional resection techniques.
Level Of Evidence:
Level III-therapeutic.
