MIDTERM Classifications Flashcards
PHASE 1 of Luck classification
PROLIFERATIVE phase
fibroblasts, cellular activity
PHASE 2 of Luck classification
ACTIVE phase
nodules form
PHASE 3 of Luck classification
RESIDUAL phase
collagen maturation
plantar fasciitis versus fasciosis
- fasciitis: more acute, INFLAMMATORY process
- fasciosis: more chronic, DEGENERATION of the fascia
pirani classification:
purpose and total possible score
- assesses the severity by using a 6-point scoring system and 6 different physical exam findings.
- 3 points assess the midfoot deformity and 3 points assess the hindfoot deformity
when performing the 6 Pirani physical exam findings,
what would be 0 points?
no abnormality
when performing the 6 Pirani physical exam findings,
what would be 0.5 points?
moderate abnormality
when performing the 6 Pirani physical exam findings,
what would be 1 point?
severe abnormality
Tx for Pirani hindfoot score > 2
>83% requiring Achilles tenotomy
Treatment for total Pirani score: 2-4
required a mean of 4 biweekly casts
Treatment for total Pirani score of 4-6
required a mean of 7 biweekly casts
dimeglio classification:
purpose and scoring system
- significant equinus indicates significant deformity/pathology,
- more equinus = more points,
- more plantarflexion of medial column = more points,
- more varus = more points,
- more internally rotated = more points
- 20-point scoring system after applying gentle corrective maneuver
- Rated I - IV based on total points
dimeglio stage I
benign (<5 points),
soft-soft, resolving
dimeglio stage II
moderate (5-9 points)
soft-stiff, reducible, partly resistant
dimeglio stage III
severe (10-14 points), stiff-soft, resistant, partly reducible
dimeglio stage IV
very severe (15-19 points),
stiff-stiff, resistant
seddon classification: overview
- classification of nerve injury
- describes into:
- Neurapraxia
- Axonotmesis
- Neurotmesis
neurapraxia
(seddon)
- conduction deficit without damage to the axon
- Least severe (contusion/compression)
axonotmesis
(seddon)
- axon damage without endoneurial tube damage
- Wallerian degeneration – degeneration of the axon distal to the injury
- May cause muscle atrophy
neurotmesis
(seddon)
- nerve severance with complete disruption of the endoneurial tube
- Most severe – irreversible with muscle atrophy
sunderland classification:
purpose and overview
- classify peripheral nerve injuries PRODUCING LOSS OF FUNCTION
- 1st Degree - 5th Degree
1st degree
(sunderland)
axon is preserved with temporary conduction block
2nd degree
(sunderland)
axon is (reversibly) damaged,
but the endoneurial sheath is preserved
3rd degree
(sunderland)
axon and endoneurial sheath are damaged,
but fasciculi (perineurium) are intact
4th degree
(sunderland)
nerve fascicule is destroyed and only held together by connective tissue
5th degree
(sunderland)
complete loss of nerve trunk continuity
Johnson & Strom/Myerson Classification:
purpose and scale
- classify severity of Tibialis Posterior Dysfunction (adult acquired flatfoot)
- levels of severity
- stage I
- stage II
- IIa - IIe
- stage III
- stage IV (added by myerson)
stage 1
(Johnson & Strom/Myerson)
- tenosynovitis with mild tendon degeneration (normal length and function)
- without osseous deformity and with flexible rearfoot,
- mild weakness of single heel raise
stage II
(Johnson & Strom/Myerson)
- tendonitis (elongated with degeneration),
- flexible rearfoot,
- weak heel rise + too many toes sign
stage III
(Johnson & Strom/Myerson)
- longstanding deformity,
- elongated and ruptured tendon,
- rigid valgus rearfoot,
- marked weakness of single heel raise + too many toes sign
stage IV
(Johnson & Strom/Myerson)
- same as stage III + rigid ankle valgus,
- rigid deformity of the hindfoot with valgus tilt secondary to deltoid insufficiency and spring ligament attenuation
stage IIA
(Johnson & Strom/Myerson)
stage II tendonitis + hindfoot valgus
stage IIB
(Johnson & Strom/Myerson)
stage II tendonitis + flexible forefoot supination
stage IIC
(Johnson & Strom/Myerson)
stage II tendonitis + fixed forefoot supination
stage IID
(Johnson & Strom/Myerson)
stage II tendonitis + forefoot abduction
stage IIE
(Johnson & Strom/Myerson)
stage II tendonitis + medial ray instability
type I
(MRI classification of TP Dysfunction)
hypertrophic,
as tendon responds to injury
type II
(MRI classification of TP Dysfunction)
candle wicking,
narrowing at point of injury as tendon stretches
type III
(MRI classification of TP Dysfunction)
full rupture (less common)
Stage I
- (Johnson & Strom/Myerson)*
- Recommended Tx*
-
conservative treatment, tenosynovectomy, tendon debridement
- Generally wouldn’t inject tendon with steroids
Stage II
- (Johnson & Strom/Myerson)*
- Recommended Tx*
- tendon transfer, calcaneal osteotomies, arthroeresis, medial column procedures, isolated rearfoot fusions
- MC tx: medial calcaneal slide (Kouts) and either a FDL transfer (or some other type of medial procedure, ex: Hoke)
Stage III
- (Johnson & Strom/Myerson)*
- Recommended Tx*
- isolated rearfoot arthrodesis, double arthrodesis, triple arthrodesis
Stage IV
- (Johnson & Strom/Myerson)*
- Recommended Tx*
TTC arthrodesis, pantalar arthrodesis
