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Comparison of initial compression force across the subtalar joint by two different screw fixation techniques
Christine Gosch1, Robert Verrette, Derek P Lindsey
1Surgical Division, Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA, USA. Christine.Gosch@med.va.gov
Summary
Two screw orientations for subtalar fusion yielded similar compressive forces. The plantar-to-superior approach offers an alternative for revision subtalar arthrodesis when standard techniques are not feasible.
Area of Science:
- Orthopedic Surgery
- Biomechanics
- Foot and Ankle Reconstruction
Background:
- Subtalar joint arthrodesis is a common procedure for treating hindfoot pathology.
- Fixation techniques aim to achieve solid bony union across the joint.
- Screw orientation may influence the biomechanical stability of the fusion.
Purpose of the Study:
- To compare the compressive force across the subtalar joint using two different screw orientations in a simulated fusion model.
- To evaluate the efficacy of plantar-versus-posterior screw approaches for subtalar arthrodesis.
Main Methods:
- Eight paired fresh-frozen cadaver feet were utilized.
- Bone mineral density was assessed using dual-energy x-ray absorptiometry.
- A load-sensing washer measured compression force for plantar-to-superior and posterior-to-anterior screw fixation.
Main Results:
- Mean compression force for the posterior-to-anterior approach was 581 N (SD 242 N).
- Mean compression force for the plantar-to-superior approach was 604 N (SD 276 N).
- No significant difference in compression force was observed between the two screw orientations (P = .74).
Conclusions:
- Both posterior-to-anterior and plantar-to-superior screw fixation techniques provide comparable compressive forces in simulated subtalar fusion.
- The plantar-to-superior approach serves as a viable alternative for subtalar arthrodesis, particularly in revision cases.
- This technique may be beneficial when standard fixation methods are contraindicated.
