SLR - December 2023 - John
Title: Is There a Benefit to Rigid Fixation in Calcaneal Lengthening Osteotomy in Painful Pediatric Idiopathic Flatfoot Deformity? Comparing Results of Kirschner Wire Versus Plate FixationReference: Tippabhatla, Abhishek, et al. "Is There a Benefit to Rigid Fixation in Calcaneal Lengthening Osteotomy in Painful Pediatric Idiopathic Flatfoot Deformity? Comparing Results of Kirschner Wire Versus Plate Fixation." Journal of Pediatric Orthopaedics 43.10 (2023)
Level of Evidence: 3
Scientific Literature Review
Reviewed by: Melody John, DPM
Residency Program: St. Mary’s General Hospital – Passaic, New Jersey
Podiatric Relevance: Investigates the radiographic, patient-reported outcomes, and complications in pediatric patients who underwent calcaneal lengthening osteotomy (CLO) using Kirschner wire versus plate fixation. There are disadvantages to both fixation methods. Disadvantages to plate fixation include hardware failure, loosening, plate discomfort, deep tissue infection, greater biological insult due to soft tissue dissection and bone stripping, and nonunion. Disadvantages to K-wire fixation include higher rates of superficial wound infections, pin site irritation, pin migration, potential loss of reduction, and in rare instances, deep tissue infections and osteomyelitis. This study explores the clinical and radiographic improvements, and complications using K-wire versus plate fixation in CLO.
Methods: This was a single center retrospective study of 65 patients (102 feet) who underwent CLO using Kirschner wire or plate fixation from 2015 to 2020. Plates were used in 60 feet while 42 underwent K-wire fixation. Primary outcomes consisted of weightbearing radiographic parameters and post-operative complications. Secondary outcomes included patient-reported outcomes.
Results: Both fixation methods significantly improved radiographic measurements, AP talo-first metatarsal and calcaneal pitch angles. Slightly lower AP talo-first metatarsal angles were noted post-operatively in the plate fixation group, but the difference between the two groups was not clinically significant. Pain and mobility scores were not statistically different in the two groups. 12/60 feet who underwent plate fixation had complications, whereas there were only two complications in the K-wire fixation group. Secondary surgery was needed for removal of painful hardware in 10 feet who underwent plate fixation. Both groups had low infection rates, but K-wires had rates of 2.4% for both deep and superficial infections, and plates had rates of 1.7%. Potential complications for plate fixation include hardware failure, loosening, plate discomfort, deep tissue infection, greater biological insult due to soft tissue dissection and bone stripping, and nonunion.
Conclusion: There was no significant difference in the radiographic and clinical outcomes between the two methods of fixation after calcaneal lengthening osteotomy in children with painful forefoot deformities. There was a significant difference in reoperation rates for painful hardware in patients who had plate fixation. Therefore, this study advocates for the use of K-wire fixation in children undergoing calcaneal lengthening osteotomy secondary to the low reoperation rates, and clinical and radiographic improvements.