Precision of targeting device for subtalar screw placement.

Abstract

When performing subtalar arthrodesis, proper screw placement is fundamental to provide primary stability and to help ensure bone healing. In inexperienced hands this step can be time-consuming and exposes surgeons and patients to radiation. By means of a targeting device these potential drawbacks and dangers could be reduced. It was hypothesized that a specifically designed targeting device would reduce radiation exposure while improving screw placement when compared with the conventional "free-hand'' method. Twenty matched-pairs of cadaveric hindfoot specimens (Thiel fixation) were prepared for the purpose of the study. The specimens were randomly assigned into two groups consisting of 10 specimens each: in Group 1 screw placement was performed with the targeting device and in Group 2 screw placement was performed under fluoroscopic control. Screw placement was radiographically judged to be optimal, suboptimal and poor. An experienced, fellowship-trained foot and ankle surgeon and a resident, who had never done subtalar fusions performed the screw placements. Exposure to radiation was assessed by means of the dose area product given by the fluoroscope. Optimal screw positioning was achieved in both groups in ten out of 20 specimens (Group 1, n=5; Group 2, n=5). Suboptimal screw placement was found in eight cases (Group 1, n=4; Group 2, n=4). There were two failures which occurred in fusions performed by the resident (Group 1, n=1; Group 2, n=1). Exposure to radiation was significantly reduced in Group 1 when compared with Group 2 (4.1cGy* cm2 versus 8.1cGy* cm2; p=0.012). No lesion of neurovascular structures due to aiming device placement occurred in Group 1. A target-device for screw-placement did not provide a significant technical advantage but did result in less radiation exposure.