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ABSTRACT: Delayed union and nonunion of fractures exist in the pediatric population. Fracture healing requires the synergistic collaboration of mechanical support and robust biological processes to allow endochondral ossification, reestablishment of bone continuity, and subsequent remodeling to strong lamellar bone. Failure of either mechanical stability or biology may manifest as delayed fracture healing. While early recognition of potential metabolic and pharmacologic risk factors may be addressed by pre-emptive treatment using nutritional and vitamin D supplements, definitive treatment of established nonunion requires a comprehensive approach. Key Concepts: (1) Delayed unions and nonunions are more common in adult bone but can also occur in pediatric bone. (2) Fracture healing requires synergistic collaboration of mechanical support and robust biological processes; treatment of nonunions should address both the biological and mechanical factors. (3) Vitamin D is an integral component of calcium absorption and bone health.

ABSTRACT: Background: Most children and adolescents who have flexible pes planovalgus (PPV) are asymptomatic, however some have significant daily foot pain that limits their activities. Current acceptable treatment options are conservative measures or full foot reconstruction and at present there is no “middle ground” treatment in the United States. The Subtalar Extra-Articular Screw Arthroereisis (SESA) (aka “calcaneo-stop”) procedure offers a minimally invasive option for PPV correction, and is done commonly in Europe with satisfactory results. Its not clear why this procedure has not yet been widely adopted in North America. The purpose of this study was to assess early single surgeon experience and patient satisfaction in North America with the SESA for treatment of flexible PPV. Methods: A single-center tertiary care departmental database was queried retrospectively to identify patients who had undergone treatment for PPV with SESA correction from 2018–2022. Patients and their caregivers were surveyed cross-sectionally for patient satisfaction and functional outcomes. Demographic, clinical, radiologic, and outcome data were summarized by patient and by foot. Changes in radiographic measurements were assessed using paired t-tests. Results: Thirty-seven feet (51% female) with PPV treated with SESA correction in 20 patients were analyzed at an average of 12 months (8–21 mo) after surgery. Average patient age was 13.3 years (SD, 2.3; Range, 9.4–18.8) at surgery. Concomitant procedures were done in 20 feet (63%), including 12 Achilles lengthenings, 5 accessory navicular excisions, 2 medial distal femoral hemiepiphysiodesis, and 1 hallux valgus correction. Mean radiographic improvement was seen from preoperative to postoperative: (1) standing anterior-posterior (SAP) talus-1st metatarsal angle of 14.6 degrees (P