title: Partial or non-union after triple arthrodesis in children: does it really matter?
abstract: OBJECTIVE
  Triple arthrodesis is a commonly performed salvage procedure to correct hindfoot deformity. Non-union is considered an undesirable radiographic outcome; however, the clinical ramifications of this are not as well defined. The purpose of this study was to determine the incidence of partial or complete radiographic non-union after triple arthrodesis in children and characterize the clinical consequences.
  
  
  METHODS
  An IRB-approved retrospective review of triple arthrodesis surgeries in patients less than 16 years of age performed by a single surgeon (DSW) identified 159 cases meeting the inclusion criteria. Plain radiographs were reviewed for bony fusion (defined as over 80 % radiographic bony union of the subtalar, calcaneocuboid, and talonavicular bones) and charts for clinical outcomes (pain, return to activity, and subsequent hindfoot surgeries). Statistics were used to compare the fused and unfused cases, with p < 0.05 considered to be significant.
  
  
  RESULTS
  Of the 159 cases included in the study, 9 % did not achieve at least 80 % plain film radiographic union. The fused and unfused groups had similar clinical outcomes. Only one patient required surgery for sequelae of symptoms arising from a pseudoarthrosis related to the triple arthrodesis. The fused and unfused groups were similar in terms of gender and pin removal time, but differed significantly in surgical age and underlying diagnosis.
  
  
  CONCLUSIONS
  This is one of the largest case series of pediatric triple arthrodesis surgery presented in the literature. This study demonstrated that good clinical outcomes can be achieved despite the lack of radiographic union after triple arthrodesis surgery in children.
  
  
  METHODS
  IV.
authors.affiliation: Northeast Ohio Medical University, Rootstown, OH, 44272, USA.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Wicks
authors.affiliation: Akron Children's Hospital, Akron, OH, 44308, USA.
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Morscher
authors.affiliation: Akron Children's Hospital, Akron, OH, 44308, USA.
authors.forename: Meadow
authors.initials: M
authors.lastname: Newton
authors.affiliation: Department of Statistics, University of Akron, Akron, OH, 44325, USA.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Steiner
authors.affiliation: Northeast Ohio Medical University, Rootstown, OH, 44272, USA. mdicintio@chmca.org.|Department of Pediatric Orthopaedic Surgery, Akron Children's Hospital, Akron, OH, USA. mdicintio@chmca.org.|Regional Skeletal Dysplasia Clinic, Akron Children's Hospital, Akron, OH, 44302, USA. mdicintio@chmca.org.|Akron Children's Hospital, 300 Locust Street, Ste. 250, Akron, OH, 44302-1821, USA. mdicintio@chmca.org.
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Weiner
keywords: Calcaneocuboid joint; Hindfoot deformity; Hindfoot fusion; Pseudoarthrosis; Radiographic non-union; Subtalar joint; Talonavicular joint; Triple arthrodesis