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Subtalar arthrodesis using a single compression screw: a comparison of results between anterograde and retrograde screwing

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

The primary objective of this study was to compare the radiological and clinical results of anterograde and retrograde screwing in subtalar arthrodesis using a single compression screw. The secondary objective was to evaluate the subjective results and consolidation of this procedure. The hypotheses were that isolated screw fixation was sufficient to achieve good consolidation and that there was no difference between the two techniques with a similar rate of bone fusion.

Methods

This is a monocentric, retrospective, radio-clinical study based on 99 patients (101 feet), 58 males and 41 females, with an average age of 64 years. The main aetiology was post-traumatic osteoarthritis, which represented 51% of cases. Two groups were formed: group A (52 feet) consisting of fixed arthrodesis with ascending (retrograde) screwing and group D (49 feet) consisting of fixed arthrodesis with descending (anterograde) screwing. The two groups were statistically comparable in terms of demographic data as well as aetiologies and comorbidities. Arthrodeses which were not fused at 6 months were reassessed at one year and in the event of any radio-clinical doubt regarding consolidation, an additional CT scan was prescribed. Average post-operative follow-up was 11 ± 5 years (2–27 years).

Results

Ninety-two arthrodeses (93%) were fused at one year and 9 were considered to be in non-union, 5 (9.8%) in group A, and 4 (8.3%) in group D. We recorded 30 complications, 22 of which were due to a conflict with the screw head, 18 (34.5%) in group A and 4 (8.3%) in group D (p = 0.03). Conflict between the screw head and the heel led to the removal of the screw after consolidation of the arthrodesis. The clinical results were evaluated using Odom’s criteria. Nine per cent of patients described their results as excellent, 29% as good, 51% as satisfactory and 11% found the result to be poor.

Conclusion

The fusion rate for isolated compression screw arthrodesis is good, and there is no difference between anterograde and retrograde screws. However, the discomfort caused by the screw head being insufficiently embedded in the retrograde group led to a non-negligible number of additional surgeries to remove the screw.

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Authors and Affiliations

  1. University Grenoble Alpes, CHU Grenoble-Alpes Site de Voiron, Route des Gorges, 38500, Voiron, France

    D. Saragaglia

  2. Department of Osteoarthritis and Sport Surgery, Grenoble-Alpes CHU, South Teaching Hospital, Kimberley Avenue, BP 338, 38434, Échirolles Cedex, France

    JC. Giunta, J. Gaillot & B. Rubens-Duval

  3. Centre Ostéo-Articulaire Des Cèdres, Parc Sud Galaxie, 5 rue des Tropiques, 38130, Échirolles, France

    Y. Tourné

Authors
  1. D. Saragaglia
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  2. JC. Giunta
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  3. J. Gaillot
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  4. Y. Tourné
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  5. B. Rubens-Duval
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Correspondence to D. Saragaglia.

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All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. It is a retrospective analysis of routine care.

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Informed consent was obtained from all individual participants included in the study.

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Saragaglia, D., Giunta, J., Gaillot, J. et al. Subtalar arthrodesis using a single compression screw: a comparison of results between anterograde and retrograde screwing. Eur J Orthop Surg Traumatol 32, 1583–1589 (2022). https://doi.org/10.1007/s00590-021-03141-7

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  • DOI: https://doi.org/10.1007/s00590-021-03141-7

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