Reproducibility of Computed Tomography to Evaluate Ankle and Hindfoot Fusions

Cerrato, Rebecca; Aiyer, Amiethab; Campbell, John T.; Jeng, Clifford L.; Myerson, Mark S.

doi:10.1177/1071100714544521

Cited by 31 publications

(17 citation statements)

References 13 publications

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“…Third, in our study, weightbearing conventional radiographs were used to evaluate the fusion status. CT scans have been shown to have high reliability in determining the degree of successful fusion of the hindfoot [6]. However, in our study, only patients with a suspected nonunion or delayed union underwent CT, as it would be impractical to obtain CT in all patients.…”

Section: Discussionmentioning

confidence: 87%

Hindfoot Arthrodesis with the Blade Plate: Increased Risk of Complications and Nonunion in a Complex Patient Population

Gorman

Beals

Nickisch

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Previous hindfoot surgeries present a unique challenge to hindfoot arthrodesis, as the patients may have multiple incisions around the hindfoot. In high-risk patients with compromised soft tissues, a posterior approach can provide an alternative for a fresh soft tissue plane for the surgery. The use of a blade plate construct is widely accepted; however, there are limited data supporting the use of a posterior approach. Questions/purposes We asked (1) what proportion of patients treated with this technique achieved osseous union; (2) what complications were observed; (3) were any patient-demographic or health-related factors associated with the likelihood that a patient would have a complication develop? Methods Between December 2001 and July 2014, 42 patients received a posterior blade plate. During the period in question, indications for hindfoot arthrodesis using posterior blade fixation were subtalar osteoarthritis below an ankle fusion, malunion or nonunion, failed tibiotalocalcaneal arthrodesis attributable to nonunion of the tibiotalar and/or subtalar joint; or tibiotalar and subtalar osteoarthritis in patients with impaired bone or soft tissue quality (particularly if the soft tissue problem was anterior). During that period, all patients who met those indications were treated with a posterior blade plate. Forty (95%) were included in this study, and two were lost to followup before the 1-year minimum required by the study. Demographics (age, gender, BMI, smoking status, and comorbidities) and surgical data (indication, previous treatment, and additional procedures) were analyzed. Of the 40 patients included, 27 (68%) were male and 13 (33%) were female, with a median of two previous hindfoot or ankle surgeries (range, 0-9 surgeries). The mean age of the patients was 56 ± 13 years. Followup averaged 47 ± 28 months (range, 14-137

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Section: Discussionmentioning

confidence: 87%

Hindfoot Arthrodesis with the Blade Plate: Increased Risk of Complications and Nonunion in a Complex Patient Population

Gorman

Beals

Nickisch

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…8 A later report correlated the degree of fusion identified on CT scan with the functional outcome and found that an arthrodesis area of 25% to 50% was necessary for clinical success. 5 The same study found no statistically significant interrater reliability for the evaluation of ankle fusion by CT scan in contrast to subtalar fusion, which had a high interrater reliability. 5 In our series, we did not use CT scan to assess ankle fusion.…”

Section: Discussionmentioning

confidence: 90%

“…11,13,14,16,33 CT has been described as being instrumental in determining the adequacy of arthrodesis in the foot and ankle. 5 An earlier report was not certain what percentage of radiographic fusion defines a successful arthrodesis. 8 A later report correlated the degree of fusion identified on CT scan with the functional outcome and found that an arthrodesis area of 25% to 50% was necessary for clinical success.…”

Section: Discussionmentioning

confidence: 99%

Hybrid Fixation for Ankle Fusion in Diabetic Charcot Arthropathy

et al. 2017

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“…There is substantial disagreement in the literature regarding diagnostic criteria for arthrodesis nonunion. In addition, some recent articles have demonstrated clinical outcomes that diverge from the criteria commonly used in these cases 3 , 5, 6, 7, 8…”

Section: Discussionmentioning

confidence: 99%

“…Pseudoarthrosis, or nonunion, is one of the most frequent complications, occurring in up to 40% of cases 3 , 4 . The definition of consolidation after arthrodesis can be challenging in some scenarios 5, 6, 7, 8. Some factors require careful analysis, especially in cases with an equivocal outcome.…”

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confidence: 99%

Ankle Arthroscopy as an Adjunctive Method for Diagnosis of Nonunion After Tibiotalar Arthrodesis

Cruz

2019

Arthroscopy Techniques

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The definition of consolidation after ankle arthrodesis can be challenging in some situations. Computed tomography has increased diagnostic accuracy; however, there are still no clear criteria for nonunion. In this context, arthroscopy with direct visualization of the arthrodesis may provide crucial data to inform the choice of treatment. The present report illustrates a case in which arthroscopy prompted a change in treatment strategy. More extensive surgery, with the potential for greater morbidity due to revision arthrodesis, could be avoided.

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Reproducibility of Computed Tomography to Evaluate Ankle and Hindfoot Fusions

Abstract: Level IV, case series.

Cited by 31 publications

References 13 publications

Hindfoot Arthrodesis with the Blade Plate: Increased Risk of Complications and Nonunion in a Complex Patient Population

Hindfoot Arthrodesis with the Blade Plate: Increased Risk of Complications and Nonunion in a Complex Patient Population

Hybrid Fixation for Ankle Fusion in Diabetic Charcot Arthropathy

Ankle Arthroscopy as an Adjunctive Method for Diagnosis of Nonunion After Tibiotalar Arthrodesis

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