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Accuracy of posterior subtalar joint injection without fluoroscopy
Kevin L Kirk1, John T Campbell, Gregory P Guyton
1Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, MD 21218, USA.
Clinical Orthopaedics and Related Research
|April 12, 2008
Summary
Accurate posterior subtalar joint injections are possible for experienced surgeons without fluoroscopy. However, uncontrolled fluid spread into surrounding structures like the ankle or peroneal sheath can occur, limiting injection selectivity.
Area of Science:
- Orthopaedic Surgery
- Radiology
- Anatomy
Background:
- Accuracy of posterior subtalar joint injections lacks radiographic validation.
- Need for precise needle placement in foot and ankle procedures.
Purpose of the Study:
- To evaluate the accuracy and selectivity of posterior subtalar joint injections by experienced surgeons without fluoroscopic guidance.
- To determine if fluoroscopy is essential for accurate intraarticular needle placement.
Main Methods:
- Three fellowship-trained foot and ankle surgeons performed posterior subtalar joint injections on 20 cadaveric specimens each.
- An anterolateral approach was used for all injections.
- Radiographic assessment of needle placement accuracy and extravasation was performed by an independent, blinded radiologist.
Main Results:
- 58 out of 60 (96.7%) injections were accurately placed within the posterior subtalar joint.
- Two injections (3.3%) were found to be extraarticular.
- Extravasation occurred in 14 samples into the ankle joint and in 2 samples into the peroneal tendon sheath.
Conclusions:
- Experienced surgeons can achieve high accuracy for posterior subtalar joint injections without fluoroscopy in normal joints.
- Selectivity is limited due to unpredictable extravasation into adjacent structures without fluoroscopic guidance.
- Fluoroscopy is recommended for diagnostic injections, surgical decision-making, or when the joint is abnormal to ensure targeted delivery.
