title: The use of a portable CT scanner for the intraoperative assessment of talocalcaneal coalition resections.
abstract: BACKGROUND
  Intraoperative assessment of talocalcaneal (TC) coalition resection can be challenging, with no reliable plain radiographic view available for evaluation. Therefore, in March of 2011, we began using a CereTom portable CT scanner to assess TC coalition resections intraoperatively. This study evaluates the use of intraoperative CT during surgical resection of TC coalitions.
  
  
  METHODS
  Patients who received CT scans before and after TC coalition resection, by a single surgeon, were included. Those treated without (control group, n=12 feet) and with (intraoperative CT group, n=14 feet) intraoperative CT scan were retrospectively compared. Two blinded pediatric orthopaedic surgeons assessed the quality of resection using a side-by-side comparison of preoperative and postoperative CT scans. Each resection was rated as "excellent," "fair," or "poor," and medical records were reviewed to evaluate clinical outcome.
  
  
  RESULTS
  Substantial agreement was found between blinded reviewers (κ=0.71, 81% absolute agreement). Quality of resection was improved in the intraoperative CT group, with 57% of patients receiving an excellent rating compared with 25% in the control group. Patients in the intraoperative CT group were 4.0 times more likely to have a complete resection as compared with patients in the control group; however, this was not statistically significant (odds ratio, P>0.05; 95% confidence interval, 0.74-21.5). Intraoperative CT altered surgical decision making in 3 feet (21%) in the intraoperative CT group, leading to further resection and a subsequent excellent postoperative rating in 2 of these patients. There was 1 reoperation in the control group for continued pain and residual coalition identified on postoperative CT scan. In the intraoperative CT group there have been no reoperations for recurrent or residual qcoalition.
  
  
  CONCLUSIONS
  This study illustrates that intraoperative CT can alter surgical decision making and may improve the ability to obtain a complete resection in TC coalition surgery. In these technically challenging cases, intraoperative scans give immediate imaging feedback to surgeons, allowing intervention if residual resection is identified. If intraoperative CT scan is available, it should be considered for surgical treatment of TC coalition resections.
  
  
  METHODS
  Level III retrospective case-control study.
authors: *Department of Orthopedics, Rady Children's Hospital and Health Center †Department of Orthopedics, University of California-San Diego, San Diego, CA.
authors: John
authors: J
authors: Kemppainen
authors: Andrew T
authors: AT
authors: Pennock
authors: Joanna H
authors: JH
authors: Roocroft
authors: Tracey P
authors: TP
authors: Bastrom
authors: Scott J
authors: SJ
authors: Mubarak
mesh_terms: D000293:Adolescent; D002111:Calcaneus / Q000002:abnormalities / Q000601:surgery*; D016022:Case-Control Studies; D002648:Child; D005532:Foot Deformities, Congenital / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D012189:Retrospective Studies; D013628:Talus / Q000002:abnormalities / Q000601:surgery*; D015898:Tomography Scanners, X-Ray Computed; D014057:Tomography, X-Ray Computed