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Pediatric Orthopedics > Tarsal Coalition > Flashcards

Tarsal Coalition Flashcards

1
Q

What are tarsal coalitions

A

Relatively rare anomaly
Presents with varying degrees of fusion and/or restricted movement between two or more tarsal bones
A union between two bones of the tarsus via a bar or bridge

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2
Q

Describe the types of tarsal unions

A

Osseous (synostosis)
Cartilaginous (synchondrosis)
Fibrous (syndesmosis)

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3
Q

What are the two locations tarsal coalitions may exist

A

Intra-articular
Extra-articular

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4
Q

What are the different tarsal coalition classifications

A

Congenital or acquired
Complete or incomplete
Intra-articular or extra-articular (Buckholtz)
Symptomatic or asymptomatic
Anatomic location (Downey)

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5
Q

According to Downey’s Classification, what is Juvenile Type I

A

Extra-articular coalition

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6
Q

According to Downey’s Classification, what is Juvenile Type II

A

Intra-articular coalition

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7
Q

In Downey’s classification, what is type A vs B

A

A - no secondary arthritis
B - secondary arthritis

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8
Q

What is the treatment for Juvenile IA coalition

A

Resection with interposition of EDB muscle, adipose, implant

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9
Q

What is the treatment for Juvenile IB coalition

A

Resection with interposition of EDB muscle, adipose, implant
Triple arthrodesis (failed resection)

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10
Q

What is the treatment for Juvenile IIA

A

Resection with interpositional arthroeresis
Isolated single arthrodesis
Triple arthrodesis

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11
Q

Treatment for Juvenile IIB

A

Triple arthrodesis after skeletal maturity

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12
Q

Describe the intra-articular location of the a coalition

A

May be present between two osseous segments that fuse within an anatomical joint with destruction of the existing joint

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13
Q

Is TC coalition intra-articular or extra-articular

A

Intra-articular

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14
Q

Describe the location of extra-articular coalition

A

A bar or bridge that fuse so tarsal bones outside an anatomical joint

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15
Q

Is CN bar intra-articular or extra-articulr

A

Extra-articular

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16
Q

What are the two categories of coalition etiologies

A

Congenital
Acquired

17
Q

What are the types of acquired coalitions

A

Traumatic
Metabolic
Infectious
Neoplastic

18
Q

What is the most common cause of tarsal coalitions

A

Traumatic

19
Q

What are two most common types of tarsal coalitions

A

Talocalcaneal & calcaneonavicular
- talocalcaneal most common asymptomatic
- calcaneonavicular most common symptomatic

20
Q

What radiographic view is used for talocalcaneal coalitions

A

Harris Beath Study

21
Q

Symptomatic talo-calcaneal coalitions tend to be _______ or _____ facet

A

Middle or anterior facet

22
Q

What is the 3rd most common tarsal coalition after talocalcaneal and calcaneonavicular

A

Talonavicular

23
Q

What are some associated disorders with coalition

A

Symphalangism = ankylosis of phalangeal joints
34% of clubfoot patients have tarsal coalitions
Peroneal spastic flatfoot especially calcaneo-navicular
Tibialis spastic varus feet
Tibial dysplasia
Lower bone densities than normal patients

24
Q

What is the age range for TN coalition pain

A

3-5 years

25
Q

What is the age range for CN coalition pain

A

8-12 years

26
Q

What is the age range for TC coalition pain

A

12-16 years

27
Q

What are different images for coalitions

A

Harris & Beath
Isherwood
Conway & Cowell
Goldman
Resnick
Smith & Staple
Jay

28
Q

What is the computed tomography study of choice for coalitions

A

Smith &’ Staple

29
Q

Smith & Staple: _____ plane for STJ coalitions

A

Coronal

30
Q

Smith & Staple: _____ plane for TN & CC coalitions

A

Transverse

31
Q

What is the MRI study of choice for coalitions

A

Jay

32
Q

What radiographic signs are seen on TC coalitions

A

Anterior superior TN joint beaking
Halo effect of talocalcaneal articulation
Flattening & broadening of lateral talar process
Loss of STJ clarity via loss of middle and posterior STJs
Ball and socket ankle joint

33
Q

What radiographic sings are seen on calcaneal-navicular collation

A

Anteater sign
Comma sign

34
Q

What are the conservative treatments for coalitions

A

Orthotics
BK cast
NSAIDs
Intra-articular steroid injections
PT

35
Q

What are the surgical treatments for C-N Bar

A

Badgley bar resection

36
Q

What are the surgical treatments for T-C coalitions

A

Triple arthrodesis
Middle facet bridge resection
Fat pad tarsi arthroeresis
STJ fusion interposition
Resection with sinus
Grice-Green extra articular arthrodesis
Resection with extra-articular arthrodesis

Pediatric Orthopedics (18 decks)

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