Background/Objectives: Subtalar arthroereisis (STA) is a widely used surgical procedure for symptomatic pediatric flexible flatfoot. However, implant migration remains a concern due to its potential impact on long-term correction and complications. This study evaluated the migration pattern of STA implants and assessed long-term clinical and radiographic outcomes. Methods: This retrospective cohort study included 47 feet from children aged 8–13 years who underwent STA with adjunctive soft tissue procedures between 2014 and 2018, following ≥6 months of failed conservative treatment, with a minimum follow-up of 5 years. Exclusion criteria included neuromuscular or rigid flatfoot. Weight-bearing radiographs assessed anteroposterior (AP) and lateral Meary’s angles, reflecting forefoot-to-hindfoot alignment, and calcaneal pitch, indicative of longitudinal arch height. Implant migration was recorded and clinical outcomes were measured by the American Orthopedic Foot and Ankle Society (AOFAS) score. Measurements were recorded preoperatively, immediately postoperatively, and at 1 month, 3 months, 6 months, 1 year, and 5 years. Results: Radiographic correction was significant and sustained at 5 years. The AP Meary’s angle improved from 13.09° to 5.26° at 1 month and 6.69° at 5 years (p < 0.001); lateral Meary’s angle from 9.77° to 4.06° and 4.88° (p < 0.001); and calcaneal pitch from 14.52° to 16.87° and 16.89° (p < 0.001), respectively. AOFAS scores increased from 67.52 to 90.86 at 1 month and 96.33 at 5 years (p < 0.001). Implant migration peaked within the first postoperative month (mean: 3.2 mm on ankle AP view; 3.0 mm on foot AP view) and stabilized thereafter. Four cases of complications included implant dislodgement, subsidence, and persistent sinus tarsi tenderness, which were successfully resolved after appropriate management. No recurrence of deformity was observed. Conclusions: STA implant migration is most pronounced during the first month, likely due to physiological settling as the foot adapts to altered biomechanics. With appropriate implant selection, technique, and follow-up, migration does not compromise long-term correction or outcomes. In general, symptomatic cases can often be managed conservatively prior to implant removal.

Background: Forearm fractures involving both bones are common orthopedic injuries. Children have a higher tolerance for greater displacement and angulation owing to the remodeling potential. The optimal fixation method for managing pediatric forearm fractures has not been definitively established. This study evaluated the safety and efficacy of a stepwise surgical algorithm, wherein single-bone plating was attempted first, and both-bone fixation was strictly reserved for cases demonstrating persistent intraoperative instability. Methods: In this retrospective analysis, we evaluated 48 skeletally immature children with both-bone forearm fractures managed via our stepwise protocol. Initially, single-bone plating was performed. Dynamic manual stress testing was then applied under fluoroscopy. If the unplated bone exhibited rotational instability, residual angulation >15°, or translation >50%, the procedure was converted to both-bone plating (Group B, n = 16). Patients who achieved stable alignment without requiring a second plate formed Group A (n = 32). Results: Both groups achieved 100% union. Postoperative angulations of the radius on the anteroposterior view were 1.91 ± 2.73° in Group A and 0.88 ± 1.96° in Group B; meanwhile, the lateral angulation of the radius in Groups A and B was 1.88 ± 3.56° and 0.00 ± 0.00°, respectively. The anteroposterior angulation of the ulna was 2.31 ± 3.60° in Group A and 2.19 ± 4.00° in Group B, whereas the lateral angulation of the ulna was 2.81 ± 3.74° in Group A and 1.75 ± 3.47° in Group B. Only the lateral angulation of the radius showed a significant difference (p = 0.0418). In the subgroup analysis, minor differences in ulna angulation on the anteroposterior view reached statistical significance in the older cohort (p = 0.027) and in the distal-third fracture group (p = 0.001). No differences in bone healing or functional outcomes were observed, and complication rates were similar. Conclusion: Our stepwise surgical algorithm appears to be a safe and effective approach. By adhering to this protocol, 66.7% of patients were successfully spared the morbidity of a second incision, while all patients achieved solid union and excellent functional outcomes. However, further high-quality studies are essential to establish comprehensive protocols for intraoperative stability assessment and postoperative care.

Background/Objectives: Progressive collapsing foot deformity (PCFD) is driven by multiplanar peritalar instability. This study evaluated the clinical and radiographic outcomes of a standardized four-component reconstruction protocol designed to facilitate immediate postoperative weight-bearing in Stage 1a/1b PCFD. Methods: This single-center retrospective study included 20 patients treated between 2015 and 2023 with medializing calcaneal osteotomy, spring ligament repair, flexor digitorum longus (FDL) tendon transfer with internal brace augmentation, and subtalar arthroereisis. Clinical (VAS, AOFAS) and radiographic parameters (anteroposterior and lateral Meary angles, calcaneal pitch, and talonavicular coverage angle) were assessed longitudinally, with subgroup analysis comparing implant removal versus retention. Results: The protocol yielded significant overall improvements. Mean VAS decreased by 4.37 points (p < 0.001), and final AOFAS reached 84.7 ± 7.6 at the final follow-up. Although subtalar arthroereisis was removed in 45% of patients due to symptomatic irritation, subgroup analysis revealed no significant loss of radiographic correction (p > 0.05). Notably, a significant interaction effect was observed for VAS scores (p = 0.002) and AOFAS scores (p = 0.041), with the removal group demonstrating a pronounced functional recovery trajectory following explantation. No major complications occurred. Conclusions: A standardized four-in-one reconstruction provides reliable multiplanar correction in Stage 1a/1b PCFD. The maintenance of structural alignment despite a high implant removal rate supports the role of arthroereisis as a temporary but valuable adjunct for early mobilization. This strategy offers a reproducible framework for joint-preserving PCFD management.