Accuracy of Posterior Subtalar Joint Injection Without Fluoroscopy |
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Authors: | Kevin L Kirk John T Campbell Gregory P Guyton Lew C Schon |
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Institution: | (1) Department of Orthopaedic Surgery, Union Memorial Hospital, 3333 N Calvert Street, Suite 400, Baltimore, MD 21218, USA;(2) The Institute for Foot and Ankle Reconstruction at Mercy, Mercy Medical Center, Baltimore, MD, USA |
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Abstract: | Injection into the posterior subtalar joint has not been validated for accuracy using radiographic end points. We asked whether
needle placement into a normal posterior subtalar joint could be performed accurately and selectively by experienced surgeons
without fluoroscopic guidance. Three fellowship-trained orthopaedic foot and ankle surgeons each injected the posterior subtalar
joint of 20 cadaveric specimens using an anterolateral approach. Fluoroscopic images were obtained by an independent investigator
and blinded. A separate fellowship-trained foot and ankle surgeon interpreted the images. Of 60 injections, 58 were accurate
and two were extraarticular based on interpretation by an independent foot and ankle surgeon. Extravasation into the ankle
occurred in 14 samples and into the peroneal sheath in two samples. Experienced surgeons can place intraarticular injections
into a radiographically normal posterior subtalar joint without fluoroscopy with a high degree of accuracy. However, extravasation
into the ankle or peroneal tendon sheath occurred in an unpredictable fashion, suggesting selectivity of injection placement
is relatively limited without the use of fluoroscopy. Fluoroscopy may not be necessary for injections used solely for therapeutic
purposes. However, if the injection is intended for diagnostic purposes or to assist in surgical decision-making or if the
joint is abnormal, we recommend fluoroscopy to ensure the subtalar joint is the only anatomic structure impacted by the injection.
One or more of the authors (K.K., J.C., G.G., and L.S.) have received funding from a nondirected Zimmer research grant.
The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department
of the Army, Department of Defense, or the U.S. Government. |
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