Distal interphalangeal joint arthrodesis comparing tension-band wire and Herbert screw: a biomechanical and dimensional analysis

Thirty cadaveric distal interphalangeal joints (15 male and 15 female joints) were prepared with either a Herbert screw or a tension-band wire technique to simulate an arthrodesis. To elucidate mechanical differences between these constructs, the strength of the specimens was determined for three-point anteroposterior and lateral bending and for axial torsion. The Herbert screw demonstrated significantly greater anteroposterior bending strength and greater torsional rigidity when compared to the tension-band wire technique. For dimensional analysis, the height and width of each distal phalanx was measured prior to fixation, 4 mm from the distal tip of the bone (the region that must accommodate the large-diameter threads of the Herbert screw). Results indicated that the mean height of the distal phalanx (3.55 mm) is smaller than the diameter of the screw (3.90 mm). Fracture or thread penetration at the tip of the distal phalanx during screw placement occurred in 25 of the specimens overall and in all the female phalanges, often resulting in stretching or violation of the nail bed. Despite fracture or screw penetration, the Herbert screw appears to offer additional strength that may be clinically important for joint arthrodesis.     

Iliac crest bone grafting and Herbert screw fixation of nonunions of the scaphoid with avascular proximal poles

Between 1989 and 1991, 137 nonunions of the scaphoid were treated by the senior author, who noted that 26 of these nonunions had an avascular proximal pole (no punctate bleeding from the bone at the time of surgery). All 26 nonunions were treated with iliac crest bone grafting and Herbert screw fixation. Of these 26 patients, 17 were followed for more than 1 year after their surgery (average follow-up period, 31 months). The average time from injury to surgery was 31 months. Of the 17 patients included in this study, 12 were treated with a palmar approach to the nonunion, 5 with a dorsal approach. The 12 nonunions that occurred at either a midwaist or distal location were approached through a palmar modified Russe incision and treated with interpositional corticocancellous iliac crest bone graft in addition to the Herbert bone screw. The five nonunions with a very small proximal fragment were approached through a dorsal incision and treated with cancellous iliac crest bone graft and Herbert screw fixation. All patients were immobilized after operation in a short-arm thumb spica cast for 3 months and were then allowed active range of motion of their wrists. Return to full activity was permitted once preoperative wrist motion was restored. Radiographic union, as defined as bridging trabeculae of bone present in all x-ray films, occurred in nine patients, an incomplete union or persistent fibrous union in seven, and a nonunion in one patient. Using the scaphoid outcome score, an assessment scale based on pain, occupation, wrist motion, strength, and patient satisfaction, functional results were graded as excellent in six patients, good in five patients, fair in four patients, and poor in two patients. The average range of motion of the wrist did not significantly improve after surgery, but the average grip strength of the injured hand increased by 29 lbs. There were no intraoperative complications. However, three patients required further operative procedures including radial styloidectomy, pin removal, and carpal tunnel release. No patient has required either a proximal row carpectomy or wrist arthrodesis. Previously published results of avascular proximal pole scaphoid nonunions suggest that union cannot be obtained and functional results are uniformly poor. In contrast, the functional and x-ray results of our patients are markedly improved over these previous studies--emphasizing the importance of iliac crest bone grafting, rigid internal fixation, and appropriate postoperative immobilization.     

Occipitocervical fusion with a five-millimeter malleable rod and segmental fixation

Although occipitocervical fusion is frequently used for instability of the upper cervical spine and the occipitocervical articulation, most currently used techniques have one or more of the following disadvantages: the necessity for sublaminar wires, the use of occipital screws, a fixed angle of instrumentation, or the necessity for routine postoperative halo immobilization. Moreover, many reported techniques are associated with a high rate of nonunion or instrumentation failure. We present our experience with a technically simple method of obtaining rigid occipitocervical arthrodesis using a 5-mm malleable rod that is fixed to the skull by a pair of wires passed through four suboccipital burr holes. Segmental spinal fixation is achieved with Wisconsin interspinous wires and is occasionally supplemented with sublaminar wires. Supplemental autogenous bone graft is used in all cases. A cervical collar is routinely used for postoperative immobilization. The results of treatment were retrospectively reviewed in 16 patients with an average age of 49.4 years (range, 9-69). Mean follow-up was 24 months (range, 12-36 mo). The indication for fusion was instability of the occiput-C1-C2 complex as a result of Chiari malformation, rheumatoid disease, skull base tumor resection, basilar invagination, ankylosing spondylitis, Down's syndrome, cervical laminectomy, and trauma. The average number of levels fused was 5.4 (range, O-C3 to O-T3). Successful occipitocervical arthrodesis was achieved in all but one of the surviving patients. The single patient with a pseudarthrosis was successfully managed with supplemental bone grafting and halo immobilization. There were two deaths from medical complications in chronically ill patients. Other complications included one postoperative instrumentation loosening, one myocardial infarction, and one superficial occipital decubitus. In conclusion, rodding and segmental interspinous wiring is an effective, technically simple method of obtaining rigid occipitocervical fixation, which obviates the need for bulky orthoses.     

A comparison of fixation screws for the scaphoid during application of cyclical bending loads

Matched pairs of scaphoids from cadavera were stressed with ramped intensity cyclical bending loads after osteotomy and fixation of one scaphoid with a Herbert screw and fixation of the other with an AO 3.5-millimeter cannulated screw, a Herbert-Whipple screw, an Acutrak cannulated screw, or a Universal Compression screw. The AO screw, Acutrak screw, and Herbert-Whipple screw demonstrated superior resistance to cyclical bending loads compared with the Herbert screw. The Universal Compression screw did not provide better fixation than the Herbert screw because of fractures that occurred at the time of insertion. The AO screw and the Herbert screw were then tested in a separate setup in which a segment of volar cortex had been removed in addition to the simple osteotomy. The loss of volar cortex greatly diminished the quality of the fixation provided by both of the screws during application of ramped intensity cyclical bending loads. CLINICAL RELEVANCE: A fixation device in the scaphoid must be able to withstand the stresses that are placed on the scaphoid as a result of its position spanning the proximal and distal carpal rows. Also, because of the prolonged time required for healing of fractures or non-unions of the scaphoid, the device must be able to withstand many such cycles of stress. The present study demonstrates that commonly used screws for fixation of the scaphoid vary significantly (p < 0.005) in their ability to resist cyclical bending loads.     

Role of internal and external fixation in ankle fusion

Between August 1980 and September 1993, 35 tibiotalar arthrodeses in 34 patients with primary and secondary osteoarthritis of the ankle were performed. Two different surgical techniques were employed. Internal screw fixation according to Wagner and Pock [20] and an external fixation method according to the resection compression arthrodesis by Charnley and Muller [14]. Twenty patients with 21 fusions could be investigated retrospectively. For evaluation we used self-assessment, clinical examination and radiographic analysis in combination with the score described by McGuire et al. [12]. In 80% the results were good and satisfactory with a median improvement of 23 score points on a scale of 100% 95 points, respectively. The most important advantages were pain relief and increase of walking distance. The fusion rate was 95%. We found osteoarthritis in the neighbouring joints did not have any influence on the surgical result. With respect to the two surgical techniques, the internal screw fixation method achieved fusion earlier with fewer complications and better improvement according to the McGuire score. Tibiotalar fusion is a safe therapy with reproducible good results involving pain relief, full weight-bearing and increase of walking distance.     

Repair of defects in spondylolysis by segmental pedicular screw hook fixation. A preliminary report

STUDY DESIGN: Clinical testing of segmental pedicular screw hook fixation repairing defects in lumbar spondylolysis. OBJECTIVES: The authors tested segmental pedicular screw hook fixation using ISOLA implants (AcroMed Corp., Cleveland, OH) to maintain direct repair of the defect in pars interarticularis while fusion occurs. The device should not break while fusion takes place with out a postoperative body cast. SUMMARY OF BACKGROUND DATA: Previous techniques of direct repair of defects in lumbar spondylolysis have not been successful universally, and wire breakage has occurred despite the use of a postoperative body cast. METHODS: This technique stabilizes bone grafted to the detect by a pedicular screw, a hook, and a rod used in combination. Six patients with lumbar spondylolysis were treated by means of this technique. RESULTS: Postoperatively, all patients with low back pain or radicular pain experienced significant relief. Radiographs, including lateral flexion-extension radiographs and tomograms, showed five patients to have a bilateral union and one a unilateral union, and none of the instrumentation failed. CONCLUSION: This technique is considered useful for direct repair of the defects found in lumbar spondylolysis.     

Arthrodesis of finger joints by dynamic external compression using dorsoventral Kirschner wires and rubber bands

A new method is presented for arthrodesis of small joints in the hand. In this method Kirschner wires are inserted dorsoventrally through the phalanges on either side of the joint, and the external ends bent into hooks. Longitudinal compression is achieved by connecting these hooks with rubber bands. This technique gives a solid and painless immobilization in a proper position, and the latter can be corrected easily when necessary. We arthrodesed 46 joints in 39 patients by this method in 1975 and 1976. The fusion time was 4 to 6 weeks, and the method produced a good bony arthrodesis in 42 of the 46 fingers.     

Combined tibio-talar and subtalar arthrodesis by retrograde nail in hindfoot rheumatoid arthritis

PURPOSE OF THE STUDY: Many techniques for ankle arthrodesis have been described. Some are not applicable to patients with severe rheumatoid arthritis (RA) because of osteopenia and deformities. This study describes a new surgical technique for arthrodesis in painful valgus deformity of the hind-foot in advanced rheumatoid arthritis (RA) with severe osteopenia. MATERIALS: The present series included 9 patients. Eleven talocrural and talocalcaneal arthrodeses were performed for degenerative changes secondary to RA involving hind-foot joints. All patients were reviewed after an average follow-up of 6 years. Mean duration of RA was 34 years. All patients had severe osteopenia, including major deformations of the hind-foot in 5 cases. METHODS: After removal of talocrural and talocalcaneal articular surfaces using an anterolateral approach, deformities were corrected by removal of an appropriate bone wedge. A Küntscher nail was then positioned in the calcaneal plantar cortical through the plantar surface of the foot and driven proximally into the medullary canal of the tibia through the talus. This nail allowed both deformity correction and fixation. Aftercare required immobilization in a short leg cast. Weight bearing was allowed with the cast approximately 5 weeks after surgery. The ankle was immobilized for 7.5 weeks. DISCUSSION: Results showed a 80 per cent fusion rate. Two non-unions occurred (one recurrence of valgus deformity after early nail migration requiring removal of the nail; and the other asymptomatic). A complication occurred in one foot (delayed healing). At follow-up, all patients but one were satisfied with respect to pain relief and residual deformities. Our results are comparable with those of other series and should be considered in the context of severe RA. CONCLUSION: This technique of vertical retrograde transarticular nailing allows an easy control of hind-foot deformities correction. Other techniques are preferable in case of solid bone. This technique is an acceptable alternative in advanced RA.     

Translaminar screw fixation of the lumbar and lumbosacral spine. A 5-year follow-up

STUDY DESIGN: In a retrospective study, the long-term results of translaminar facet screw fixation of the lumbar and lumbosacral spine are reviewed. OBJECTIVES: To evaluate the clinical results, fusion rates and complications of this posterior fusion technique in various conditions of the lumbar spine. SUMMARY OF BACKGROUND DATA: Posterior fusion of the lumbar and lumbosacral spine is one of the possible methods to relieve pain and eliminate instability in degenerative conditions. Data in the literature support the use of internal fixation to optimize the rate of fusion. METHODS: Posterior lumbar and lumbosacral fixation with translaminar screws and fusion in 173 patients with degenerative changes with or without compressive syndromes including failed back syndromes, monosegmental hypermobilities, and posttraumatic conditions were investigated. Fixation and fusion with translaminar screws was performed in 57% monosegmentally, in 40% across two segments and in 2% over three segments. Decompressive surgery was performed in addition in 52% and nucleotomy in 30% of the cases. Clinical and radiologic assessment with flexion/extension x-rays was performed in 145 (83%) patients by two independent orthopedic surgeons. After an average follow-up of 68 months (range, 52-83). RESULTS: Ninety-four percent of the patients showed solid bony fusion in the radiologic follow-up. Loosening of the screws was noted in 3%, and two screws were broken without apparent motion on the functional x-rays. Pain scores decreased from 7.6 before surgery to 2.9 after surgery on a 10-point pain scale. The results were further analyzed according to Stauffer and Coventry with 99 good results, 70 satisfactory results, and 4 bad results. CONCLUSIONS: Translaminar screw fixation offers an immediate postoperative stability of the lumbar and lumbosacral spine and enhances fusion. In the present series no neurologic complications were noted. It represents a useful and inexpensive technique for short segment fusion of the nontraumatic lumbar and lumbosacral spine.     

Biomechanical assessment of compression screws

A series of mechanical tests on anatomic specimen cancellous bone and cancellous bonelike foam were conducted to evaluate and compare an Acutrak compression screw with an AO 4-mm cancellous screw and the Herbert screw. The Acutrak and AO screws produced similar fragment compression in foam and bone; Acutrak and AO compression were significantly greater than that of the Herbert screw. However, Acutrak was able to maintain compression after cyclic loading significantly better than were the AO and Herbert screws. The pushout force of Acutrak and AO screws were significantly greater than that of the Herbert screw in foam and bone. The torque required to break fragment contact was significantly greater for the Acutrak than for the AO or Herbert screws, but that for the AO was greater than that for the Herbert screw. The results of this analysis show the Acutrak screw is capable of producing and maintaining compression between bone fracture fragments. In addition, the Acutrak screw was shown to have superior mechanical characteristics than did Herbert screw in every mode tested. The Acutrak screw did not surpass the fragment compression achieved by the AO screw in foam, but it did not overtighten or experience degradation of compression after 500 cycles of simulated physiologic loading.     

Pedicle screw fixation for arthrodesis of the lumbosacral spine in the elderly. An outcome study

STUDY DESIGN: An analysis of the outcome and effectiveness of instrumented arthrodesis of the lumbosacral spine in elderly patients conducted using a review of records, assessment of fusion via plain radiographs, and a two-part questionnaire. OBJECTIVE: To ascertain the outcome and efficacy of instrumented arthrodesis of the lumbosacral spine in patients 60 years of age and older. BACKGROUND DATA: From 1987 to 1991, 38 patients of at least 60 years of age underwent instrumented arthrodesis of the lumbosacral spine using the Wiltse or Selby pedicle screw fixation system (Advanced Spine Fixation Systems, Inc., Irvine, CA). Patients were considered for surgery only after attempts at conservative management, including physical therapy, medication, injection blocks, and home exercises, had proven unsuccessful. METHODS: Follow-up examinations were performed 3 months, 6 months, 1 year, and 2 years after surgery. Fusion was assessed using plain radiographs, including flexion-extension films. Inpatient and outpatient records were reviewed, and a two-part questionnaire was used to establish the effect of surgery on function and lifestyle. Thirty patients responded to the questionnaire. Follow-up observation of the patients ranged from 25 to 56 months. The mean age was 73.8 years (range, 60-90 years). RESULTS: The mean co-morbidity was 1.7. Based on the authors' method of evaluation of fusion, the fusion rate was 92%. Fifty-seven percent of the patients reported excellent or good results, 26% reported fair results, and 17% reported poor results. Functional gains of 50% or more were reported by 71% of the respondents. Female patients had significantly more complications than male patients, but reported comparable outcomes. CONCLUSION: Despite the increase in age, co-morbidity, and associated risk of perioperative complications inherent in this population, an outcome comparable with that of younger patients is reported.     

Wrist fusion

Wrist arthrodesis is a reliable procedure for the treatment of a variety of disorders of the wrist. It provides predictable pain relief, enhanced hand function, and a high degree of patient satisfaction. The AO/ASIF wrist fusion plate allows rigid internal fixation and optimizes wrist position for maximum hand function. In comparison to other wrist arthrodesis techniques, the wrist fusion plate produces a high rate of fusion utilizing local bone graft from the distal radius.     

Burst fractures of the second through fifth lumbar vertebrae. Clinical and radiographic results

Fifty-five patients who had sustained a burst fracture of the lumbar spine were followed for a mean of seventy-nine months (range, twenty-four to 192 months) after the injury. Thirty patients had been managed non-operatively with a short period of bed rest followed by protected mobilization. The remaining twenty-five patients had been managed operatively: eight, with posterior arthrodesis with long-segment hook-and-rod fixation; eight, with posterior arthrodesis with short-segment transpedicular fixation; six, with posterior arthrodesis and instrumentation followed by anterior decompression and arthrodesis; and three, with anterior decompression and arthrodesis. Thirty-six patients had been neurologically intact at the time of presentation and had remained so throughout the follow-up period. No neurological deterioration or symptoms of late spinal stenosis were seen. Isolated partial single-nerve-root deficits resolved regardless of the method of treatment. Patients who had had a complete single or a multiple-nerve-root paralysis seemed to have benefited from anterior decompression. Although the anatomical results as seen on the most recent radiographs were superior for the group that had been managed operatively with long posterior fixation or anterior and posterior arthrodesis, the most recent pain scores and the functional outcomes were similar for all treatment groups. At the latest follow-up evaluation, some loss of spinal alignment was noted in the patients who had been managed with short transpedicular fixation; the alignment at the most recent follow-up examination was comparable with that in the patients who had been managed non-operatively. For the patients who had had non-operative treatment, we were unable to predict the deformity at the time of follow-up on the basis of the initial diagnostic radiographs. The clinical outcome was not related to the deformity at the latest follow-up evaluation. On the basis of the results of our study, we recommend non-operative treatment for patients who do not have neurological dysfunction or who have an isolated partial nerve-root deficit at the time of presentation. For patients who have a multiple-nerve-root paralysis, anterior decompression is indicated.     

Hip fusion in young adults. Using a medial displacement osteotomy and cobra plate

Eight consecutive patients, mean age 17.25 years, underwent a medial displacement osteotomy and hip arthrodesis with a nine-hole Cobra plate. A transverse innominate osteotomy facilitated medial displacement of the femoral head and acetabulum. Alignment of the lower limb at 25 degrees flexion, neutral abduction, and neutral rotation was assisted by a long-limbed protractor and Steinmann pins placed in both anterior superior iliac spines. The greater trochanter was reattached to the Cobra plate so that hip abductor function could be restored should the fusion ever be converted to an arthroplasty. No postoperative immobilization was required. All patients had radiographic evidence of union by 12 months. One patient had a postoperative brachial plexus neuropraxia that resolved at three months. One patient required an ipsilateral femoral lengthening for limb-length inequality secondary to collapse of his femoral head before hip fusion. At a mean follow-up interval of 2.8 years (range, one to 4.5 years), all patients had significant improvements in pain (p < 0.05), function (p < 0.01), and gait (p < 0.01). The average preoperative Harris Hip Score of 45 points +/- 8 points (mean +/- SEM) improved to 84 points +/- 2 points (p < 0.01).     

Wrist arthrodesis for failed wrist implant arthroplasty

Thirteen wrist arthrodeses were performed for failed wrist implant arthroplasties between 1984 and 1992. Twelve patients were available for review, with an average follow-up period of 28 months. The original arthroplasties consisted of 8 silicone implants and 4 metal-plastic total wrist implants. The surgical method involved a tricortical iliac bone graft and an intramedullary Steinmann pin. There were 7 excellent results, 4 good results, and 1 poor result. All but 1 patient had markedly improved function with no or mild pain. Seven patients had solid fusions and 5 patients had pseudarthroses. Four pseudarthroses occurred at the graft-metacarpal junction and 1 occurred at the graft-radius junction. Each patient with a solid fusion had an excellent result. All graft-metacarpal pseudarthroses were painless and did not limit the patients' activities. There were 17 complications in 9 patients. Wrist arthrodesis can be a successful salvage procedure for failed wrist implant arthroplasty in patients with rheumatoid arthritis. However, the complication rate can be high. Owing to the high incidence of distal graft-metacarpal pseudarthrosis, we recommend using more rigid fixation techniques in patients with failed wrist arthroplasties.     

Ankle arthrodesis in patients with rheumatoid arthritis

The results of 26 ankle arthrodeses performed for rheumatoid arthritis on 21 patients were reviewed. Tibiotalar arthrodesis was performed in 14 ankles, and tibiotalocalcaneal arthrodesis was performed in 12. External fixation was used in 20 ankles, and internal fixation was used in six. Followup was available in 24 of 26 ankles (19 patients), and averaged 5 years (range, 2-8 years). There was no pain experienced in 19 ankles; mild, occasional pain was experienced in four ankles; and moderate, daily pain was experienced in one ankle. Daily activities were limited in five patients and recreational activities were limited in 11. All patients reported some difficulty walking on uneven terrain. Nearly all patients were satisfied; two were satisfied with reservations and two were dissatisfied. Union was achieved in 25 of 26 (96%) ankles. Ankle arthrodesis is an effective operation in patients with rheumatoid arthritis. Unlike previous reports, union and complication rates in this series were comparable with rates for arthrodesis for posttraumatic and degenerative arthritis.     

Management of acute perilunate dislocations without fracture of the scaphoid

A retrospective review of 14 cases of acute perilunate dislocations without fracture of the scaphoid managed by three different forms of treatment was conducted at an average follow-up of 29 months. Treatment included closed or open reduction with cast immobilization only (n=2), closed reduction followed by percutaneous K-wire fixation of the carpus (n=4), and open reduction with repair of the torn scapholunate ligaments and K-wire fixation of the carpus (n=8). Based on Cooney's clinical scoring system, there were five excellent, five good, two fair and two poor results. The patients without ligamentous repair did as well as those with ligamentous repair when the scaphoid was reduced anatomically and stabilized with K-wires. In the latter, however, the scapholounate relationship was maintained more consistently. We believe that open reduction through a dorsal approach, direct repair of the scapholunate ligaments, and K-wire fixation of the carpus is a reliable method for obtaining satisfactory clinical and radiographic results in the management of acute perilunate dislocations without fracture of the scaphoid.     

Technique and clinical evaluation of arthroscopic ankle arthrodesis

Arthroscopic ankle arthrodesis has recently been shown to be an effective procedure with significant advantages when properly indicated. We report on the results of arthroscopic ankle fusion in 16 patients with idiopathic or posttraumatic osteoarthritis and rheumatoid disease. We used standard ankle arthroscopic technique and simple noninvasive distraction with hanging weights. All 16 patients had a successful fusion at an average of 9.5 weeks postoperatively. Complications included 1 lateral cutaneous neuroma, and 1 patient who required removal of screws because of superficial pain. Postoperative evaluation showed complete resolution of pain in 14 of 16 patients and significant improvement in gait. Fourteen of 16 patients were completely satisfied with the result and cosmesis, and only 1 patient required shoe modification. These results substantiate previous reports that arthroscopic ankle arthrodesis is successful, and where indicated, has significant advantages over the open technique.     

Fracture strengths of three core restorative materials supported with or without a prefabricated split-shank post

BACKGROUND: Conventional anterior cervical discectomy with fusion is thought to require postoperative neck immobilization for the promotion of bony fusion. Rigid internal fixation with anterior cervical plates may decrease graft-related complications and provide immediate stability. This stability may obviate postoperative external immobilization. METHODS: This report reviews one surgeon's experience with the use of rigid internal fixation for two-level anterior cervical discectomy and fusion for radiculopathy to promote early mobilization without external bracing. It compares outcomes and costs with a similar population of patients treated with anterior cervical discectomy and fusion who did not undergo rigid internal fixation. We compared patients who underwent two-level allograft anterior cervical discectomy and fusion with or without rigid internal fixation between 1989 and 1994 performed by a single surgeon (FJP) to evaluate the cost advantages and outcome of each procedure. All patients had clinical evidence of cervical radiculopathy unresponsive to medical therapy with magnetic resonance imaging confirmation of the appropriate nerve root impingement. Thirty-nine patients underwent two-level Cloward allograft fusion using Synthes anterior cervical locking plates, 25 underwent identical fusion without plating. Follow-up was 6 months to 4 years (mean, 31 months). RESULTS: Twenty-three of 25 patients in the nonplated group and 36 of 39 patients in the plated group achieved excellent or good outcomes using the Odom criteria. There were six complications (two major and four minor) in each group. Patients who underwent plating returned to light activities (mean, 17 vs. 29 days), driving (28 vs. 57 days), and unrestricted work (66 vs. 136 days) sooner than non-plated patients (p < 0.05, paired t test). No patient with plates was given external immobilization. CONCLUSIONS: Two-level anterior cervical discectomy and fusion with anterior plating for radiculopathy is safe, effective, and seems to provide shorter convalescence compared with conventional anterior cervical discectomy and fusion. Patients returned to unrestricted work sooner, thus reducing short-term disability. Rigid internal fixation may provide cost advantages to patients and insurance disability providers. The authors conclude that the increased cost of treatment for rigid internal fixation is more than offset by the benefits of earlier mobilization.     

Intraarticular foot and ankle injections to identify source of pain before arthrodesis

OBJECTIVE: The purpose of our study was to evaluate the usefulness of diagnostic joint injections in patients with foot and ankle pain when the radiologist attempts to identify the source of pain. This study also correlated the results of injection with outcome after arthrodesis. MATERIAL AND METHODS: We retrospectively reviewed the records of 22 patients who had a foot or ankle joint injected to identify a source of pain and who later underwent arthrodesis of the painful joint. All patients had long-term foot and ankle symptoms of variable causes. Twenty-four joints were assessed: 13 subtalar, five talonavicular, four ankle, one calcaneocuboid, and one metatarsocuneiform. All patients had plain radiographs, 11 had CT studies, and five had bone scans. Contrast material was used to assess adequate positioning of the needle inside the joint before injection. All joints were injected under fluoroscopic control. Steroid was added in eight joints. After injection, patients were assessed for relief of symptoms. Patients subsequently underwent arthrodesis on the basis of the results of the injection. RESULTS: In 20 patients (22 joints), long-term follow-up showed that injections allowed us to correctly identify the source of pain and successfully guide arthrodesis. Of these 20 patients, 17 had significant pain relief after injection and fusion, whereas three patients had mild or no response. With one of these patients, we injected other joints and changed surgical plans. One of the two remaining patients had more pain relief after injection than after arthrodesis. The other patient had no relief after injection, but subsequent fusion because of persistent pain was successful. We found imaging studies to be less useful than diagnostic injections when we were attempting to identify the source of pain. CONCLUSION: Intraarticular injection of anesthetic in painful foot and ankle joints helped us confirm the source of pain in 20 of 22 patients, which in turn led to successful arthrodesis and good outcomes for these patients.