title: Establishing the relationship between clinical outcome and extent of osseous bridging between computed tomography assessment in isolated hindfoot and ankle fusions.
abstract: BACKGROUND
  Determining the success of joint fusion operations is often a diagnostic dilemma, and many factors may be considered. Most would agree that the broad categories of clinical success and radiographic success are likely most useful to determine the overall success of a joint fusion operation. Very little evidence exists to assist the surgeon in determining what constitutes a successful radiographic fusion. The aim of this study was to determine the extent of osseous bridging as measured by computed tomography (CT) that was associated with a good clinical outcome as measured by the 12-Item Short Form (SF-12), Foot Function Index (FFI), and American Orthopaedic Foot & Ankle Society (AOFAS) clinical outcomes questionnaires at 24 weeks.
  
  
  METHODS
  Patients who had isolated joint fusions were evaluated (n = 275) to determine the correlation of extent of osseous bridging with clinical outcome. The extent of osseous bridging across the joint in question was categorized as absent (0%-24%), minimal (25%-49%) moderate (50%-74%), or complete (75%-100%). Clinical outcome scores included the SF-12, FFI, and AOFAS outcomes score.
  
  
  RESULTS
  Patients evaluated to have at least minimal osseous bridging at fusion sites (25%-49%) on CT reported a clinically important improvement in SF-12, FFI, and AOFAS, whereas those with "absent" osseous bridging (0%-24%) did not report a clinically important improvement in outcome scores.
  
  
  CONCLUSIONS
  This study suggests that osseous bridging of greater than 25% to 49% at the fusion site measured by CT may be necessary to consider a hindfoot or ankle fusion clinically successful.
  
  
  METHODS
  Level IV, case series.
authors.affiliation: Dalhousie University, Halifax, NS, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Glazebrook
authors.forename: William
authors.initials: W
authors.lastname: Beasley
authors.forename: Timothy
authors.initials: T
authors.lastname: Daniels
authors.forename: Peter T
authors.initials: PT
authors.lastname: Evangelista
authors.forename: Rafe
authors.initials: R
authors.lastname: Donahue
authors.forename: Alastair
authors.initials: A
authors.lastname: Younger
authors.forename: Michael S
authors.initials: MS
authors.lastname: Pinzur
authors.forename: Judith F
authors.initials: JF
authors.lastname: Baumhauer
authors.forename: Christopher W
authors.initials: CW
authors.lastname: DiGiovanni
mesh_terms: D000328:Adult; D000843:Ankle Joint / Q000000981:diagnostic imaging* / Q000601:surgery*; D001174:Arthrodesis / Q000379:methods; D016025:Bone Transplantation; D006305:Health Status Indicators; D006801:Humans; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D020127:Recovery of Function; D013380:Subtalar Joint / Q000000981:diagnostic imaging / Q000601:surgery; D013640:Tarsal Joints / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: arthritis; arthrodesis; computed tomography scan; fusion; outcome