The Predictability of Clinical Findings and Radiographs for Detecting Tarsal Coalition.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-10-15 DOI:10.1097/BPO.0000000000002830

Kianna D Nunally, Manon Pigeolet, Patricia E Miller, Jodie E Shea, Collin May, Benjamin J Shore

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引用次数: 0

Abstract

Introduction: Tarsal coalition is a disorder of the foot characterized by the abnormal union between 2 or more of the tarsal bones. A minority of patients will develop pain and limited motion when reaching adolescence, for whom surgical resection of the coalition may be necessary. The diagnostic value of clinical and radiologic signs remains unclear. The aim of this study is to assess the predictive value of clinical symptoms and plain x-rays to diagnose tarsal coalition in symptomatic patients.

Methods: We performed a retrospective chart review of patients with clinical suspicion of tarsal coalition between January 2011 and November 2019. Patient demographic data; clinical data on pain, limited motion, peroneal spasm, recurrent, or previous trauma; and radiologic data on the presence and type of coalition were collected. Multivariable general estimating equations analysis was used to assess associations between demographic and clinical characteristics and the likelihood of a positive coalition diagnosis.

Results: The study cohort was 336 patients (672 feet) with a mean age of 13 years and a 1:1 sex distribution. Thirt-eight percent of feet were diagnosed with a coalition of which 53% were talocalcaneal and 41% were calcaneonavicular. Coalitions were significantly more common in younger patients, males (OR 1.66, P=0.04), patients with lower BMI (OR 0.96, P=0.045), and patients who presented with painful feet (OR 1.59, P=0.04) or feet with limited motion (OR 7.49, P<0.001). Diagnostic utility of plain x-ray compared with CT diagnosis yielded a sensitivity of 76% and a specificity of 94%, with higher sensitivity (90%) in calcaneonavicular coalitions than in talocalcaneal (66%).

Discussion: Our study shows that limited subtalar movement, male sex, and low BMI have a high predictive value for tarsal coalition in symptomatic patients. Classic clinical findings that were not predictive of coalition in our cohort of symptomatic patients included peroneal spasm, recurrent ankle sprains, and recent trauma. Plain x-rays offer a reliable alternative to CT for diagnosis, especially for calcaneonavicular coalitions.

Level of evidence: Level III-retrospective comparative study.

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检测跗骨联合的临床结果和 X 光片的可预测性。

简介跗骨联合是一种足部疾病，其特征是两块或多块跗骨之间的异常联合。少数患者到了青春期会出现疼痛和活动受限，可能需要手术切除跗骨联合。临床和放射学体征的诊断价值尚不明确。本研究旨在评估临床症状和普通 X 光片对有症状患者诊断跗骨联合的预测价值：我们对 2011 年 1 月至 2019 年 11 月期间临床怀疑患有跗骨联合的患者进行了回顾性病历审查。我们收集了患者的人口统计学数据；关于疼痛、活动受限、腓骨痉挛、复发性或既往创伤的临床数据；以及关于跗骨联合的存在和类型的放射学数据。采用多变量一般估计方程分析评估人口统计学和临床特征与联盟诊断阳性可能性之间的关系：研究队列中有 336 名患者（672 只脚），平均年龄为 13 岁，性别分布为 1:1。百分之三十八的足部被诊断为关节联合，其中53%为距骨关节联合，41%为方骨关节联合。在年轻患者、男性（OR 1.66，P=0.04）、体重指数（BMI）较低的患者（OR 0.96，P=0.045）、足部疼痛（OR 1.59，P=0.04）或足部活动受限的患者（OR 7.49，PDiscussion.）中，合并症明显更常见：我们的研究表明，在有症状的患者中，足底活动受限、男性和低体重指数对跗骨联合有很高的预测价值。在我们这批有症状的患者中，腓骨痉挛、复发性踝关节扭伤和近期外伤等经典临床表现并不能预测跗关节炎。X光平片是诊断CT的可靠替代方法，尤其是对于小关节联盟的诊断：证据等级：III级--回顾性比较研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.