Journal of Pediatric Orthopaedics - 2026-09-03 - Journal Article
A Simplified Method for Talocalcaneal Coalition Excision.
Lam A, Hartman R, Coe KM, O'Sullivan M, Zide J, Riccio AI
Topics
Key Takeaway
A K-wire-guided simplified talocalcaneal coalition excision technique halved tourniquet time (47.5 vs. 93.4 min) and total cost ($2,887 vs. $5,819) compared to traditional resection without increasing complications.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This single-institution retrospective study compared outcomes of traditional TC coalition excision (39 feet) versus a simplified converging K-wire-guided technique (15 feet) with autogenous fat graft interposition from 2001–2025. The simplified technique produced significantly shorter tourniquet time (47.5 vs. 93.4 min), anesthesia time (58.9 vs. 118.6 min), and total cost ($2,887 vs. $5,819), all P<0.0001. No perioperative complications occurred in either group, and secondary procedure rates were equivalent at mean 2.1-year follow-up.
Key Limitation
The osseous coalition imbalance between groups (51.3% traditional vs. 13.3% simplified) was not controlled for in analysis, making it impossible to isolate the technique's contribution to time savings from coalition-type difficulty alone.
Original Abstract
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.