Journal of Pediatric Orthopaedics - 2026-07-13 - Journal Article
Single Versus Double Pin Fixation of the Calcaneocuboid Joint During Calcaneal Lengthening Osteotomy for Pediatric Idiopathic Flatfoot.
Bae K, Kwak YH, Kang MS, Ryu S, McCranie A, Ahn JH, Park SS
Topics
Key Takeaway
Double-pin CC joint fixation during calcaneal lengthening osteotomy produced a significantly higher calcaneal pitch angle at 2 years compared to single-pin fixation (19.3° vs. 16.1°, P=0.019), though CC joint subluxation index did not differ between groups.
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Summary
This study asked whether single- versus double-pin CC joint fixation during calcaneal lengthening osteotomy for pediatric idiopathic flexible flatfoot produces different radiographic outcomes at 2 years. Fifty feet (14 single-pin, 36 double-pin) were retrospectively reviewed with five radiographic angles and a CC subluxation index measured at serial intervals. Double-pin fixation yielded a significantly higher calcaneal pitch angle at 2 years (19.3° vs. 16.1°, P=0.019), but no difference was found in CC subluxation index or the remaining four radiographic parameters.
Key Limitation
The retrospective, non-randomized design with unequal group allocation (72% double-pin) means the double-pin group may represent cases where surgeons already anticipated greater instability, confounding the pitch angle difference.
Original Abstract
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-1st 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.