A Rare Intermetatarsal Coalition With Rigid Fifth Metatarsal Deformity and Symptomatic Plantar Lesion.

Coalition or synostosis of the foot is a relatively uncommon abnormality. Some cases of synostosis of the foot, primarily involving the midfoot and hindfoot, have been reported. However, intermetatarsal coalition is extremely rare, with only a small number of cases reported. We report a case of a unilateral, congenital metatarsal coalition between the fourth and fifth metatarsal bones in a 27-year-old female. She had initially been referred because of a symptomatic plantar lesion under the fifth metatarsal head. Surgery consisted of separating the affected metatarsals, combined with a proximal osteotomy, which proved successful in establishing pain-free and more natural weightbearing.

Fractured diaphyseal tibiofibular synostosis in an adolescent soccer player.

Diaphyseal tibiofibular synostosis is a rare cause of symptomatic shin pain with exertion. In this case, a 14-year-old male soccer player presented with atraumatic right shin pain made worse with running. Computed tomography revealed heterotopic ossification, or synostosis, of the tibial-fibular syndesmosis. The patient's symptoms improved with rest, without the need for operative intervention.

Management of posttraumatic radioulnar synostosis.

Posttraumatic radioulnar synostosis is a rare complication following fracture of the forearm and elbow. Risk factors for synostosis are related to the initial injury and surgical management of the fracture. Typically, patients present with complete loss of active and passive forearm pronation and supination. Evidence of bridging heterotopic bone between the radius and ulna can be seen on plain radiographs. Although nonsurgical management is sufficient in some cases, surgical excision is typically required. The timing of surgical intervention remains controversial. However, early resection between 6 and 12 months after the initial injury can be performed safely in patients with radiographic evidence of bony maturation. Surgical management consists of complete resection of the synostosis with optional interposition of biologic or synthetic materials to restore forearm rotation. A low recurrence rate can be achieved following primary radioulnar synostosis excision without the need for routine adjuvant prophylaxis.

Tarsal coalitions. Activity levels with and without surgery.

This study compares activity levels of patients with tarsal coalitions who did and did not have surgery and quantifies the return-to-activity time after tarsal coalition surgery. Thirty-one patients (mean +/- SD age, 22.1 +/- 11.6 years) with 39 coalitions (28 talocalcaneal, 1 complete talonavicular, and 10 calcaneonavicular) were included. The mean postoperative review time was 3 years. Fifteen patients (17 feet) who underwent resection had a mean +/- SD return-to-activity time of 10.3 +/- 5.8 weeks. There was no statistically significant difference in the return-to-activity time between talocalcaneal and calcaneonavicular coalitions. Thirteen patients (21 feet) quit sports; 11 (17 feet) were from the nonsurgical group. Three nonsurgical patients continued playing sports. The Fisher exact test was used to determine whether those forgoing surgery had a decreased ability to achieve desired activity levels. The correlation of surgery and failure to achieve the desired activity level was low (-0.69). Therefore, tarsal coalition excision is not correlated with failure of patients to reach desired activity levels. Patients forgoing surgery could not reach desired activity levels. Surgical excision of tarsal coalitions has a favorable outcome.

Posterior facet talocalcaneal coalition.

Posterior facet talocalcaneal coalition is one of the rarest forms of talocalcaneal coalition. When a posterior facet coalition occurs, it typically involves a majority of the posterior facet articular surface. The authors present a rare form of posterior facet talocalcaneal coalition in an 11- year-old girl. A brief review of the literature is provided, along with the case history, including radiographic findings and intraoperative and postoperative illustrations.

Symptomatic talonavicular coalition.

Talonavicular coalition is reported as an asymptomatic congenital anomaly of the foot that is noticed incidentally on radiographs of the foot, and is often associated with symphalangism, clinodactyly, ball-and-socket ankle joint, a great toe that is shorter than the second toe, and an autosomal dominant inheritance pattern. We describe here three patients with five involved feet. All three patients had chronic foot pain not secondary to trauma, and all five feet required treatment to alleviate the pain.

Skull molding caps: an adjunct to craniosynostosis surgery.

External cranial vault molding using dynamic splinting is an adjunct to surgery in the treatment of craniosynostosis skull deformities. The skull molding cap not only maintains desired skull form, but also provides further active molding to normalize skull shape. Dynamic skull remodeling from these devices occurs primarily by translational movements of bone. Traction and compression result in bony repositioning which allows further reshaping as the osteoblasts and osteoclasts respond to these stresses. Three basic designs have been described. In practice, each one must be modified to meet individual needs, and adaptations are made according to established principles of dynamic splinting.

Congenital radio-ulnar synostosis: surgical treatment.

The results of an operative approach to the problem of radio-ulnar synostosis were assessed in thirteen patients, ten to twenty-five and one-half years after the procedure was performed. We concluded that in a patient with bilateral synostosis one hand, the one not used in writing, should be shifted to a position of 20 to 35 degrees of supination. With one hand in this position, the other may be left in considerable pronation. Often after such a shift it is not necessary to rotate the second arm. However, if the pronation is marked in the second forearm, and if function is impaired unduly by this position, surgical correction is indicated. The arm should be placed in a position of 30 to 45 degrees of pronation. In unilateral radio-unlar synostosis, the ordinarily ideal position of the radius is between 10 and 20 degrees of supination. In an adult, the patient's occupation should be considered in deciding on the rotatory positions of the forearms. We usually prefer a method of transverse osteotomy through the conjoined mass of the radius and ulna. Careful observation of the effect on the vascular status of the limb during and immediately after surgery is important.