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The posterolateral fluoroscopy-guided injection technique into the posterior subtalar joint: description of the procedure and pilot study on patient outcomes

Buck, Florian ; Pfirrmann, Christian ; Brunner, Florian ; Hodler, Juerg ; Peterson, Cynthia

In: Skeletal Radiology, 2012, vol. 41, no. 6, p. 699-705

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    Title
    • The posterolateral fluoroscopy-guided injection technique into the posterior subtalar joint: description of the procedure and pilot study on patient outcomes
    Author
    • Buck, Florian. Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland
    • Pfirrmann, Christian. Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland
    • Brunner, Florian. Rheumatology, Orthopedic University Hospital Balgrist, Zurich, Switzerland
    • Hodler, Juerg. Department of Radiology, University Hospital Zurich, Zurich, Switzerland
    • Peterson, Cynthia. Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:321636
    Summary
    Objective: To describe a posterolateral fluoroscopy-guided injection technique into the posterior subtalar joint and to report patient outcomes 1month post-injection. Materials and methods: Twenty-three consecutive adult patients who underwent fluoroscopy-guided injection into the posterior subtalar joint using a direct posterolateral approach and who returned an outcomes-based postal questionnaire after receiving this injection were included. Numerical pain rating scale (NRS) data were collected prior to injection. NRS and Patient's Global Impression of Change (PGIC) scales were completed 1day, 1week, and 1month after injection. The proportion of patients who improved was calculated for each time period. Baseline NRS data were compared to each time point using the Wilcoxon test to assess differences. Spearman's correlation coefficient was used to compare the 20min NRS score with all follow-up NRS scores. All available images were reviewed for the presence of subtalar osteoarthritis (OA). Patient charts were reviewed to identify characteristics of patients referred for subtalar injections. Risk ratios were calculated comparing presence of OA or other abnormalities with improvement. Results: A posterolateral approach for fluoroscopy-guided injections into the subtalar joint is described. There was a significant reduction in the mean NRS score at all time periods compared to baseline (p ≤ 0.004). One-third of patients (7/21) reported clinically relevant improvement at 1month. Conclusions: Fluoroscopy-guided puncture of the posterior subtalar joint using a posterolateral approach is possible. Clinically significant improvement is reported in 33% of patients after 1month