Comparison of two methods of joint distraction for arthrodesis of the foot.

A study was conducted to compare the efficacy of two methods of obtaining the joint exposure needed to perform arthrodesis or exploration of various joints of the foot. The investigation was performed by means of simulated arthrodesis in a cadaveric model. On each specimen, a single investigator performed standard incisions and dissection as typically performed for surgical arthrodesis of the first metatarsocuneiform, naviculocuneiform, medial intercuneiform, talonavicular, calcaneocuboid, and subtalar joints. Each joint was exposed and distracted once using the Tarsal Joint Distractor (Orthovation LLC, Sealy, Texas) and once using the Inge Laminar Spreader (K-Medic, Northvale, New Jersey). While a given joint was distracted, a calibrated digital photograph of the exposed joint was taken from an angle best representing the surgeon's view of the articular space. Digital images were analyzed to calculate the maximum distance between articular surfaces and the total area of articular surfaces exposed while distracted. Thirty-six joints involving six feet were distracted using each device. The mean area of articular exposure was 178.3 mm(2) for the Tarsal Joint Distractor and 116.4 mm(2) for the Inge Laminar Spreader (P = .0001). The mean distance of distraction was 8.1 mm for the Tarsal Joint Distractor and 6.5 mm for the Inge Laminar Spreader (P = .0001). An average of 53.1% more exposure and 25.2% more distance between distracted surfaces was achieved when using the Tarsal Joint Distractor. The Tarsal Joint Distractor provides significantly better visualization of articular spaces typical of midfoot and rearfoot arthrodesis procedures than the Inge Laminar Spreader.