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Biomechanics & Surgery Exam 5 > Tarsal Coalitions > Flashcards

Tarsal Coalitions Flashcards

1
Q

What is a tarsal coalition?

A

when a union btwn 2 tarsal bones causes restricted motion or absence of motion

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2
Q

What is a bar?

A

extra-articular coalition that occurs outside a normal joint

Ex. calcaneonavicular bar

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3
Q

What is a bridge?

A

intra-articular coalition that occurs at a normal joint site

Ex. talocalcaneal bridge

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4
Q

give some examples of extra-articular coalitions.

A

Calcaneonavicular

Cubonavicular

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5
Q

give some examples of intra-articular coalitions.

A

talocalcaneal
talonavicular
calcaneocuboid
naviculocuneiform

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6
Q

Describe the 4 classifications of tarsal coalitions.

A
  1. etiology
  2. anatomic
  3. tissue type
  4. articular involvement
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7
Q

what is the most common cause of tarsal coalition in pediatric patients?

A

congenital etiology

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8
Q

what is the most common cause of tarsal coalition in adult patients?

A

acquired etiology

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9
Q

Describe Pfitzner’s theory of congenital cause of tarsal coalition.

A

incorporation of accessory ossicles into the normal tarsal bones

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10
Q

Describe Leboucq’s theory of congenital cause of tarsal coalition.

A

failure of differentiation and segmetnation of primitive mesenchyme

  • i.e. heritable defect (autosomal dominant)
  • occurs in 1st trimester
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11
Q

What are some acquired etiologies of tarsal coalition?

A

arthritis
infection
trauma
neoplasm

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12
Q

What is syndesmosis?

A

fibrous union

*incomplete union w/ motion

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13
Q

what is synchondrosis?

A

cartilaginous union

*incomplete union w/ motion

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14
Q

what is synostosis?

A

osseous union

*complete union without motion

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15
Q

which tissue type classification of tarsal coalition will have NO motion?

A

synostosis

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16
Q

What is the Downey classification?

A

articular involvement

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17
Q

Describe the juvenile classification. what is the difference btwn type 1 and type 2?

A

type 1- extra-articular coalition

type 2- intra-articular coalition

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18
Q

What is the difference btwn type A and type B?

A

type A- no secondary arthritis

type B- secondary arthritis

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19
Q

note that adult and juvenile articular involvement classification is the same.

A

true

20
Q

of the coalitions, which type is most common?

A

talocalcaneal coalition- 48.1%

calcaneonavicular coalition is next most common-43.6%

21
Q

of the talocalcaneal coalition, which facet is the most common?

A

middle facet

22
Q

what are some clinical findings related to tarsal coalition?

A

-limitation of motion
-rigid flatfoot
-muscle spasm
pain
*or asymptomatic!

23
Q

When does talonavicular coalition appear?

A

3-5 years

24
Q

when does calcaneonavicular coalition appear?

A

8-12 years

25
Q

when does talocalcaneal coalition appear?

A

12-16 years

26
Q

there is limitation of motion in STJ in tarsal coalition. which direction is limited?

A

STJ exhibits limited inversion

27
Q

Why is peroneal muscle spasms seen with tarsal coalition?

A

due to painful STJ motion, the peroneal tendons guard to restrict motion to eversion and immobilize the joint

28
Q

common sign or anteater sign is seen on which radiograph for which coalition?

A

seen on oblique radiograph of calcaneonavicular coalition

29
Q

what is the comma sign or anteater sign?

A

on lateral view, the anterior calcaneus has an enlarged process that looks like an anteater nose or comma sign

30
Q

halo sign is a radiographic finding of what tarsal coalition?

A

talocalcaneal coalition

31
Q

what is the halo sign?

A

sclerotic enhancement of the sustentaculum tali

32
Q

what radiographic findings are seen on lateral x-ray with a talocalcaneal coalition?

A
  • diminished posterior or middle facet
  • halo sign
  • narrowing of posterior facet
  • talonavicular beaking
  • flattening of lateral talar process
33
Q

on a calcaneal axial view, what would you see with talocalcaneal coalition?

A

facet obliquity

(normally facets are parallel or

34
Q

is talonavicular beaking a secondary arthritic finding?

A

yes

35
Q

if you saw talonavicular beaking on x-ray, how would you classify this?

A

type 2b because it is a secondary arthritic finding seen in a talocalcaneal coalition, which is intra-articular

36
Q

what are some conservative treatment options for tarsal coalition?

A 
NSAIDs
PT
shoe modifications
padding
orthotics
casting
37
Q

what surgical treatment would you use for a juvenile 1a?

A

resection w/ interposition of EDB

38
Q

what surgical treatment would you use for a juvenile 1b?

A

triple arthrodesis

39
Q

what surgical treatment would you use for a juvenile 2a?

A
  • Resection w/ interposition of arthroereisis
  • Isolated/single arthrodesis
  • Triple arthrodesis
40
Q

what surgical treatment would you use for a juvenile 2b?

A

triple arthrodesis

41
Q

in general, if you had an extra-articuilar coalition without arthritis (i.e type 1a) how would you treat?

A

resection of bone + interposition

42
Q

if you had a coalition with arthritis, how would you treat?

A 
you fuse 
(except with juvenile 2a, you can do either resection or fusion)
43
Q

what surgical treatment would you use for an adult 1a?

A
  • Resection w/ interposition of EDB muscle

* Triple arthrodesis

44
Q

what surgical treatment would you use for an adult 1b?

A
  • Resection w/ isolated/single arthrodesis

* Triple arthrodesis

45
Q

what surgical treatment would you use for an adult 2a?

A
  • Isolated/single arthrodesis

* Triple arthrodesis

46
Q

what surgical treatment would you use for an adult 2b?

A

Triple arthrodesis

47
Q

in general, how would you treat adults?

A

with fusion, bc adults dont heal as well

Biomechanics & Surgery Exam 5 (3 decks)

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