A Better Way to Do Subtalar Fusions for Post-traumatic Arthritis

Screw configuration mattered more than one might have expected

Smart Practice: Use highly divergent rather than parallel screws for subtalar fusions in patients with post-traumatic arthritis.

What’s the Claim?

A large case series of subtalar arthrodeses performed for post-traumatic arthritis following an intra-articular calcaneus fracture found two unsurprising factors were associated with nonunion (smoking and use of freeze-dried bone graft) as well as one very surprising one (use of a parallel-screw configuration for the fusion). That approach to fusion had an odds ratio (OR) of nearly 6 for nonunion when compared with an angled-screw approach, with the low end of the 95% CI still showing a 62% increase associated with using parallel screws. Nonunion was diagnosed in 13% of the patients in this series.

How’s It Stack Up?