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Guideposts for Inserting Intercuneiform Joint Arthrodesis Screws: Analysis Using Multiplanar Reconstructed Computed

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This study identifies optimal screw entry points and directions for intercuneiform arthrodesis, simplifying screw insertion for midfoot pathologies. The findings improve surgical accuracy for complex foot anatomy.

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Area of Science:

  • Orthopedic surgery
  • Foot and ankle anatomy
  • Medical imaging

Background:

  • Intercuneiform arthrodesis is crucial for treating midfoot pathologies.
  • Screw insertion for intercuneiform arthrodesis is challenging due to complex cuneiform anatomy.

Purpose of the Study:

  • To define precise screw entry points and insertion trajectories for intercuneiform arthrodesis.
  • To utilize intraoperatively detectable landmarks for surgical guidance.

Main Methods:

  • Computed tomography (CT) scans of 37 feet (10 for initial determination, 27 for validation) were analyzed.
  • Multiplanar reconstruction software (OsiriX) was used to visualize and plan screw paths.
  • Simulations were performed on normal and flat feet to assess trajectory accuracy and cortical violation.

Main Results:

  • An advisable entry point was determined on the medial aspect of the medial cuneiform, with specific dorsoplantar and anteroposterior directions.
  • The insertion trajectory aimed towards the base of the fifth metatarsal, parallel to the plantar surface.
  • Simulated screw trajectories successfully penetrated the mid three-fifths of all three cuneiforms in 97% of normal feet and 92% of flat feet without cortical violation.

Conclusions:

  • The established guideposts provide accurate and safe screw placement for intercuneiform arthrodesis.
  • This method simplifies surgical technique and potentially improves outcomes for midfoot reconstructions.
  • The findings offer valuable guidance for surgeons performing intercuneiform fusions.