Types Of Coalitions Research Articles

A retrospective magnetic resonance imaging analysis of bone and soft tissue changes associated with the spectrum of tarsal coalitions.

We aimed to investigate the bone and soft tissue changes accompanying tarsal coalition (TC) and aimed to evaluate their association with the location and type of coalition. Ankle magnetic resonance imagings of 65 patients with TC were included. The relationship between the location and type of coalition and bone marrow edema, subchondral cysts, sinus tarsi syndrome, tarsal tunnel syndrome, posterior impingement syndrome, accessory bone, tibiotalar effusion, talar osteochondritis dissecans, ganglion cysts, and calcaneal spur were evaluated. Twenty-nine patients without coalition were selected as the control group, and the distribution of these variables between the two groups was analyzed. There were 33 females and 32 males in the coalition group (mean age: 42.0 ± 15.63 years), and 22 females and seven males in the control group (mean age: 44.79 ± 12.33 years). Coalition was most common in the talocalcaneal joint (n=33, 50.8%), and the most common coalition type was non-osseous (n=57, 87.6%). We find no significant difference between the pathologies defined in terms of coalition location and type. Sinus tarsi syndrome, tarsal tunnel syndrome, subchondral cysts, and tibiotalar effusion were found to be more common in the coalition group (p=0.028, p=0.010, p=0.023, and p=0.006, respectively). The presence of coalition increased the probability of developing tarsal tunnel syndrome 9.91 times (95% CI: [1.25-78.59]; p=0.029), and sinus tarsi syndrome 3.66 times (95% CI: [1.14-11.78]; p=0.029). Tarsal coalition may predispose bone and soft tissue changes. In this study, sinus tarsi syndrome, tarsal tunnel syndrome, subchondral cysts and tibiotalar effusion were found to be more common in the coalition group.

8 out of 10 patients do well after surgery for tarsal coalitions: A systematic review on 1284 coalitions

BackgroundThe primary aim was to determine the clinical success rate after treatment for talocalcaneal (TCC) and calcaneonavicular coalitions (CNC). The secondary aim was to evaluate the complication, recurrence and revision rate. MethodsA search was carried out in MEDLINE, EMBASE and Cochrane Library. Methodological quality was assessed using the Methodological Index for Non-Randomised Studies (MINORS) criteria. The primary outcome was the clinical success rate and was pooled per type of coalition and treatment modality. 95% Confidence Intervals (CI) of the success rates were calculated. Secondary outcomes included complication rates, coalition recurrence rates, revision rates and pain improvement using the Visual Analogue Scale (VAS). A sub-analysis on interposition material was performed. Results43 articles comprising of 1284 coalitions were included, with a pooled mean follow-up of 51 months. Methodological quality was fair. The overall pooled success rate for TCCs was 79% (95% CI, 75%−83%). Conservative treatment, open resection and arthroscopic resection of TCCs resulted in success rates of 58% (95% CI, 42%−73%), 80% (95% CI, 76%−84%) and 86% (95% CI, 71%−94%), respectively. CNCs have an overall success rate of 81% (95% CI, 75%−85%), with 100% (95% CI, 34%−100%), 80% (95% CI, 74%−85%) and 100% (95% CI, 65%−100%) for conservative treatment, open resection and arthroscopic resection, respectively. Pooled complication rates of 4% (95% CI, 3%−7%) for TCCs and 6% (95% CI, 4%−11%) for CNCs were found. The success rates of resection with and without interposition material for TCCs were 83% (95% CI, 78%−87%) and 79% (95% CI, 65%−88%), and for CNCs 81% (95% CI, 76%−86%) and 69% (95% CI, 44%−85%), respectively. ConclusionTreatment of tarsal coalitions can be considered good to excellent as well as safe, with an overall clinical success rate of 79% for TCCs and 81% for CNCs. Arthroscopic resection of the coalition appears to be non-inferior to open resection of TCCs and CNCs. Level of evidenceLevel IV, Systematic Review.

Development and Implementation of a Coordinated Community Response to Address Elder Abuse and Neglect

Elder abuse, neglect, and financial exploitation impacts over five million community-dwelling older adults in the United States. Although services are available to help these victims, they are often fragmented within communities with service providers having limited means to provide preventative services. The coordinated community response (CCR) is a type of coalition intended to overcome siloed services through a single-point-of-entry system and more team-based approaches to prevention. This article describes the development, implementation, and evaluation of the interagency functioning of a local CCR. The main goal of the CCR has been to better serve victims of elder abuse, neglect, and financial exploitation. However, through the coalition's evolution, the mission of how to do this shifted from a victim service model to a prevention approach. Unique features of this CCR include a uniform consent form to allow sharing of protected client data among all service providers and a technology-supported infrastructure for service record documentation and referrals. Using available data from administrative records, the number of unique interagency referrals for services to older adults at risk increased 450% from 2016 to 2018. The strength and type of connections between agencies changed over time. Among all eligible clients offered services, most (77%) agreed to provide uniform consent to allow data sharing among other local partner agencies. The evaluation showed that the coalition met most of its planned measurable outputs in the original logic model guiding the CCR programmatic development. The evaluation findings and lessons learned inform updated guidelines for self-assessment of CCRs.

The Efficacy of Intra-articular Subtalar Steroid Injection for Symptomatic Talocalcaneal Coalitions: A 30-Year Single Institution Experience.

While intra-articular steroid injection has been used anecdotally in patients with symptomatic talocalcaneal coalitions recalcitrant to traditional conservative modalities, the ability of this treatment to provide symptomatic relief and obviate or delay surgical intervention remains unknown. The purpose of this study is, therefore, to assess the treatment efficacy of intra-articular subtalar steroid injection in children with symptomatic talocalcaneal coalitions. A retrospective study of all patients with isolated subtalar coalitions was performed at a single pediatric orthopaedic institution over a 30-year period. Radiographs were analyzed to identify the type of coalition (osseous or nonosseous), presence of any posterior facet involvement, and presence of a planovalgus foot deformity. Patients who underwent a subtalar joint steroid injection after failing other conservative treatments were identified and compared with those who did not receive an injection as part of their nonoperative management with regard to the need for ultimate surgical intervention and the time from presentation to surgery when applicable. A total of 83 patients (125 feet) met inclusion criteria, of whom 25 patients (34 feet) received a subtalar steroid injection. When compared with the 58 patients (91 feet) treated with standard nonoperative modalities, there were no differences with regard to sex, age at presentation (12.4 and 12.3 y, respectively), facet involvement, type of coalition, or the presence of a planovalgus deformity. In all, 12/34 (35%) feet in the injection group eventually elected surgical intervention compared with 36/91 (39%) feet that did not receive an injection (P=0.72). For those patients ultimately selecting surgical intervention, the average time from initial presentation to surgery was 878 days in the injection group versus 211 days in the noninjection group (P<0.001). While subtalar steroid injection can alleviate symptoms in some patients with a talocalcaneal coalition, this intervention does not appear to decrease the need for surgery when compared with traditional nonoperative therapies. In patients failing other forms of conservative treatment, subtalar steroid injections can delay surgical intervention by an average of nearly 2 years. Level-III-therapeutic study.

Comparative Analysis of Subtalar Ligaments Between Patients With Talocalcaneal Coalition and Control Subjects Using 3-Dimensional Magnetic Resonance Imaging.

The purpose of this study was to find the differences in the subtalar ligaments between patients with talocalcaneal (TC) coalition and control subjects using 3-dimensional isotropic magnetic resonance imaging. Magnetic resonance imaging of 27 ankles with TC coalition and 27 age- and sex-matched controls were retrospectively reviewed. Absence of cervical ligament, anterior capsular ligament (ACL), interosseous TC ligament (ITCL), and partial or complete absence of 3 roots of the inferior extensor retinaculum was analyzed. Thickness and width of ACL and ITCL were measured when possible. Absence of ACL and ITCL was significantly more frequent in TC coalition patients than in controls (59.2% vs 7.4%, P < 0.0001; 44.4% vs 7.4%, P = 0.004). Absence of cervical ligament and 3 roots of the inferior extensor retinaculum did not differ between the 2 groups. Thickness and width of ACL were significantly smaller in TC coalition patients than in control subjects (0.81 ± 0.23 vs 1.27 ± 0.41 mm, P < 0.0001; 5.26 ± 1.17 vs 7.07 ± 1.46 mm, P = 0.001). Thickness and width of ITCL did not differ between the 2 groups. In the TC coalition group, the absence of ACL and ITCL did not differ according to coalition type, patient demographics, and magnetic resonance imaging units. Anterior capsular ligament and ITCL are frequently absent in TC coalition patients. Even when present, the ACL is attenuated in TC coalition patients compared with controls.

Transition coalitions: toward a theory of transformative just transitions

ABSTRACT From its origins in the labor and environmental justice movements in the United States, the concept of a just transition has travelled globally as a frame to infuse concerns of justice in public responses to escalating environmental crises. However, important gaps remain in terms of understanding the potential of transition efforts to be transformative in shifting the political economic structures that cause, sustain, and deepen injustices. This article asks: what does critical sociological theory of power and social change offer for understanding the features of transformative transition coalitions as compared to those that reinforce environmental, social, and economic inequality? To this purpose, I apply insights from Antonio Gramsci and Karl Polanyi, contemporary scholars who use their theory, and environmental justice scholars to identify the means and form of transformative just transition coalitions. I identify two respective conditions of transformative coalitions: strategic power and embedded relations. Through this lens, I describe four transition coalition types: status quo, impeded, disembedded, and transformative, and discuss related examples.

A cooperative game theory approach for location-routing-inventory decisions in humanitarian relief chain incorporating stochastic planning

This paper describes a new simulation based mathematical model for locating distribution centres, vehicle routing, and inventory problems under earthquake conditions. In this paper, the proposed network includes affected areas, suppliers, distribution centres, and hospitals. Additionally, the basic infrastructures of the city, which are very fragile at the time of the earthquake, are identified. Then, the demand of each relief commodity is calculated depending on the different earthquake scenarios using simulation. The estimated demand is incorporated into the mathematical model as an uncertain parameter. The proposed methodology is designed as a two-stage model so that in the first stage the location and inventory of distribution centres are addressed. Thereafter, in the second stage the routing decisions are taken for the distribution of relief commodities from the distribution centres and suppliers to the affected areas. Due to the NP-hardness of the second stage model, this model is solved using multi-objective stochastic fractal search. This algorithm is one of the population-based and stochastic optimization techniques and inspired by the natural phenomenon of fractal growth. It should be noted that in the second stage, a cooperative game theory of coalition type is considered, which resulted in synergies that minimize the relief golden time. The kind of cooperation is the use of potential of co-operators’ vehicle. In this stage, the possibility for the players to cooperate by sharing people and commodities transportation requests is considered. Also, to validate the model, a real case study is provided for a possible earthquake in Tehran. Finally, the comparison between the simulation results and the values obtained from the real system evaluates the performance of the implemented model. Considering normality and a 95% confidence interval, it can be concluded that the proposed model provides a precise representation of the real system's performance.

Cabinet Composition, Collegiality, and Collectivity: Examining Patterns in Cabinet Committee Structure

AbstractThis article examines one arena of decision-making in cabinet government: cabinet committees. It assesses the relationship between the composition of cabinets – their party make-up – and the structure of cabinet committees. Cabinet committees are groups of ministers tasked with specific policy or coordination responsibilities and can be important mechanisms of policymaking and cabinet management. Thus, the structure of committees informs our understanding of how cabinets differ in their distributions of policy influence among ministers and parties, a central concern in parliamentary government. We investigate two such dimensions: collegiality – interaction among ministers – and collectivity, the (de)centralization of influence. We find that cabinet committees in coalitions are significantly more collegial, on average, than single-party cabinets, though this is driven by minority coalitions. At the same time, influence within cabinet committees is less collectively distributed in most types of coalitions than in single-party cabinets.

Termination of parliamentary governments: revised definitions and implications

The literature on government coalitions uses a common definition of when governments terminate and new ones form. This terminology is convenient and has served empirical coalitions studies quite well. This article challenges this terminology on the ground that it risks inflating the number of governments and, at least in some countries, severely distorts scholarly understanding of government duration and durability. Specifically, this article criticises the definitional condition that any partisan change in the composition of a government signifies its termination. The article demonstrates how using more precise definitions affects government duration considerably in a number of countries. In some cases, countries experience short-lived governments because minor partisan changes take place within a surplus coalition. Given these observations, the article re-visits the finding that minimum winning governments survive longer than oversized governments. When applying the modified definitions, differences in duration between these two types of majority coalitions almost disappear.

Bone stress injuries in the presence of tarsal coalition as a cause of hindfoot pain in adolescents: case series of 6 patients with literature review.

To highlight causal relationship between stress fracture in the presence of tarsal coalition and hindfoot pain in adolescents on magnetic resonance imaging (MRI). A retrospective review was performed of the clinical and MRI imaging findings of 6 adolescents referred for MRI to evaluate symptoms of hindfoot pain with possible tarsal coalition. MRI studies were systematically assessed for cause of hindfoot pain, types of tarsal coalition, patterns of stress fractures, bone marrow oedema and any other associated features. All the 6 patients (4 male: 2 female) aged between 12 and 19years developed insidious onset of hindfoot or midfoot pain over a period of weeks to months. On MRI, all 6 cases had features of fibrous tarsal coalition predominantly in the calcaneonavicular articulation (5 out of 6 patients). Associated stress fractures/response were in the posterior facet/body of the calcaneus (3), talar head (2), cuboid (1) and third metatarsal bone in one patient. Stress fractures/response adjacent to tarsal coalition could be because of altered biomechanics and can be an unusual cause of hindfoot pain in adolescents. A high index of suspicion and complementary MRI findings is crucial to interpret this condition to direct appropriate patient management.

The Advocacy Coalition Index: A new approach for identifying advocacy coalitions

AbstractPolicy scholars have increasingly focused on collaborative and competitive relationships between stakeholder coalitions. The Advocacy Coalition Framework (ACF) in particular has directed scholarly attention toward such relationships. The ACF defines advocacy coalitions as groups of actors who share beliefs and coordinate their action. However, previous research has been inconsistent in defining and measuring coalitions, which has hampered comparative research and theory building. We present a method called the Advocacy Coalition Index, which measures belief similarity and the coordination of action in a manner that makes it possible to assess the extent to which advocacy coalitions are found in policy subsystems, whether subgroups resemble coalitions, and how individual actors contribute to coalition formation. The index provides a standardized method for identifying coalitions that can be applied to comparative research. To illustrate the effectiveness of the index, we analyze two climate change policy subsystems, namely Finland and Sweden, which have been shown to differ in terms of the association of belief similarity with coordination. We demonstrate that the index performs well in identifying the different types of subsystems, coalitions, and actors that contribute the most to coalition formation, as well as those involved in cross‐coalition brokerage.

Clinical and functional outcomes of tarsal coalition resection to correct rigid flat foot

Objective: This study used the AOFAS score to assess the clinical functional results of patients who underwent tarsal coalition resection. Methods: This was a retrospective case series of patients who underwent tarsal coalition resection to correct rigid flat foot. Clinical and functional assessment was performed with the AOFAS score before and 6 months after surgical treatment. Descriptive analysis was performed for 7 patients (11 operated feet) using measurements of position and dispersion (mean, standard deviation, minimum, median and maximum value) for continuous variables and frequency tables (absolute and relative) for categorical variables. Results: The mean patient age was 10 years, 7 months, and the majority (71.43%) were male. The most affected joint was the calcaneonavicular. The right side was affected in 54.55% of the cases. The most frequent type of coalition was osseous (81.82% of the cases). The mean pre- and postoperative AOFAS scores were 32.7 and 70.2 points, respectively, which was a significant increase. Conclusion: The increased scores after coalition resection was considered the main change between the two assessments. Thus, it can be concluded that in rigid flat feet without severe hind- or forefoot deformities for which conservative treatment failed, bar resection should be the surgical procedure of choice. Level of Evidence IV; Therapeutic Studies; Case Series.

Prospective Evaluation of Tarsal Coalition Excision Show Significant Improvements in Pain and Function.

Excision of pediatric tarsal coalition has been successful in most patients. However, some patients have ongoing pain after coalition excision. This study prospectively assessed patient-based clinical outcomes before and after surgical excision of tarsal coalition, with particular emphasis on comparison to radiologic imaging. We prospectively studied 55 patients who had symptomatic coalition excision for 2 years postoperatively. Patients filled out the modified American Orthopaedic Foot and Ankle Society score, the University of California Los Angeles activity score, and the simple question "does foot pain limit your activity" at 4 different time points: preoperative, 6 months postoperative, 12 months postoperative, and 24 months postoperative. Comparisons were done utilizing patient demographics, imaging parameters, and patient-reported outcomes. Compared with preoperative levels, patients showed improvements in all outcome parameters. Patients with calcaneonavicular coalitions showed initial rapid improvement with later slight decline, while patients with talocalcaneal coalitions showed more steady improvement; both were similar at 2 years postoperatively. This prospective study demonstrated remarkable clinical improvements after tarsal coalition excision regardless coalition type, though postoperative courses differed between calcaneonavicular and talocalcaneal types. Finally, a subset of patients has ongoing activity limiting foot pain after coalition excision which could not be explained by the data in this study. Level II-prospective cohort study.

Protocol for a hybrid type 3 cluster randomized trial of a technical assistance system supporting coalitions and evidence-based drug prevention programs

BackgroundOver 5000 community anti-drug coalitions operating in the USA serve as a cornerstone of federal drug prevention. These coalitions, however, have demonstrated effectiveness in preventing substance use only when they use technical assistance (TA) and implement evidence-based programs (EBPs). The absence of TA and EBP implementation by coalitions is a key research-to-practice gap. The Coalition Check-Up TA system is designed to fill this gap by supporting community coalition implementation of EBPs. Existing TA models for evidence-based coalition approaches are resource intensive and coalition model specific. The Coalition Check-Up is a lower cost strategy that works with a variety of types of coalitions to support sustainable implementation of EBPs. This study protocol describes a hybrid type 3 effectiveness-implementation trial applying Wandersman’s Interactive Systems Framework to test the effects of the Coalition Check-Up on coalition EBP implementation capacity and outcomes. The Interactive Systems Framework outlines how the prevention support system—especially TA—bolsters EBP dissemination and implementation.MethodsUsing a cluster randomized controlled design, this trial will test the overall effectiveness of the Coalition Check-Up, including how it contributes to EBP implementation and prevention of youth substance use. The first aim is to estimate the impact of the Coalition Check-Up on coalitions’ capacity to do their work. We will recruit 68 anti-drug coalitions for random assignment to the Coalition Check-Up or “TA as usual” condition. We will evaluate whether the Coalition Check-Up improves coalition capacity using measures of coalition member responses about team processes, coalition network composition, and collaborative structure. Our second aim is to estimate the impact of the Coalition Check-Up on implementation of EBPs, and our third aim is to estimate the impact of the Coalition Check-Up on youth substance use.DiscussionThis project will clarify how the Coalition Check-Up, a scalable approach to TA due to its low cost, affects coalition capacity to support EBP implementation. Analyses also provide insight into causal pathways from the prevention support system to the prevention delivery system outlined by the Interactive Systems Framework. Results will build the evidence-base for how to support community coalitions’ sustainable implementation of evidence-based prevention programs and policies.Trial registrationClinicaltrials.gov registration number NCT04592120. Registered on October 19, 2020.

Osteochondritis dissecans of the talar dome in patients with tarsal coalition.

Tarsal coalition is known to cause abnormal talocrural stress, hindfoot malalignment, and ankle sprains. These can all be associated with osteochondritis dissecans (OCD) of the talar dome. We present the first detailed description of a series of talar OCDs occurring in patients with tarsal coalition, with the goal of determining whether there is an increased prevalence of OCDs among patients with tarsal coalition. We studied ankle MRIs in 57 patients with tarsal coalitions, excluding those with a reported inciting traumatic event. The MRIs were performed on magnetic field strengths ranging from 0.3 to 1.5T and included axial, coronal, and sagittal T1 and T2 or PD fat-suppressed sequences. We evaluated the morphology and location of classically described OCDs in these patients, type and location of concomitant tarsal coalition, and, when available, the presence of pes planus and hindfoot valgus on weight-bearing radiographs. Chi-squared analysis was used to compare categorical variables and a Student's t test was used for parametric continuous variables. Additionally, logistic regression was used to compute the odds ratio of talar OCD associated with patient age, gender, laterality, pes planus status, hindfoot valgus status, and coalition type. Eighty-nine percent of tarsal coalitions were non-osseous coalitions and the calcaneonavicular space was the most common site of abnormal tarsal connection (54.4%). In the 29 patients with tarsal coalitions and talar OCDs, OCDs commonly occurred medially (75.9%). In the sagittal plane, talar OCDs occurred centrally, with only one case sparing the central talar dome. The mean surface area of the 29 OCDs was 89.7mm2. Both osseous coalition and hindfoot valgus were associated with smaller talar OCD mean surface area (p = 0.015 and p = 0.0001, respectively). There was no association between depth and surface area of talar OCD with either coalition location or presence of pes planus (coalition location: p = 0.455 for depth and p = 0.295 for surface area; presence of pes planus: p = 0.593 for depth and p = 0.367 for surface area). Talar OCD prevalence is higher in patients with tarsal coalition than that reported for the general population. This occurrence may relate to altered biomechanics and repetitive talocrural stress owing to altered subtalar motion, particularly given the findings of increased odds of talar OCD in older patients, as well as weak associations between OCD surface area and both non-osseous coalition and hindfoot alignment. However, we did not find any specific OCD morphologic features attributable to the precise location of the tarsal coalition.

Las coaliciones tarsianas como causa de dolor en el pie infantil: opciones terapéuticas

Background and objectiveThe tarsal coalition can be a cause of mid-hindfoot pain in older children. The objective is to analyze the types of coalition treated in our hospital from 2010 to 2019 as well as the treatment carried out. Material and methodObservational, descriptive and retrospective study of 18 patients with tarsal coalition, 8 women and 10 men, aged 11.9±2.6 years. Epidemiological data, clinical findings and imaging tests, and treatment performed were collected. ResultsTwenty-five feet (38.8% bilateral) were reviewed. The main symptom was pain. Sixty-four percent were associated with flat-valgus foot. Fifty-two percent were located in the calcaneal-scaphoid joint, and 40% in the calcaneal-talar joint. Treatment was conservative in 44.4% of cases and surgical in 56% (coalition resection). There was only one case of recurrence. The results were mostly excellent or good (88%) after a mean follow-up period of 4 years. ConclusionsThe most frequently diagnosed type of tarsal coalition was that located in the calcaneal-scaphoid joint followed by the calcaneal-talar joint, but they can appear in any joint of the foot. Almost half responded well to conservative treatment with mostly good results, but the rest required surgical treatment due to persistence of the symptoms, the results of which were excellent in all cases except one who suffered a recurrence. In cases of calcaneal-talar coalitions associated with severe hindfoot valgus, correction of this deformity, associated or not with resection of the coalition, is recommended.

Estados, alianzas y desigualdad subnacional: dos provincias argentinas en perspectiva comparada, 2003-2015

Inequality is unevenly distributed across the territory and national averages obscure this variation. This study investigates which subnational level factors can help explain differences in inequality among districts. It analyzes how subnational coalitions resist or support national governments’ redistributive policies. The main argument is that the type of national governing alliance (regressive or progressive) affects the level of provincial inequality, but mediated by the type of subnational coalition that supports or resists that national policy. This work empirically examines this claim analyzing the configurations of the national and subnational distributive alliances in two Argentine provinces and in relation to labor rights regulations in the agricultural sector between 2003 and 2015.

Сети в современном государственном управлении: конфигурации и механизмы координации

The article reveals the specifics of policy networks in the public administration system, examines in detail the basic characteristics of networks, as well as the features of the configuration and coordination mechanisms inherent in various types of network coalitions. The author examines networks in the context of their positive and negative impact on the quality of public administration, drawing attention to the conditions for the degeneration of network associations that allow the state, together with non-state actors, to solve socially significant problems into structures that threaten the integrity of the political system. In the context of the author's definition of networks in public administration, the article examines their structural components, reveals the features of the position of network actors, describes the operational functions of networks (exchange of information, financial resources and dissemination of knowledge), emphasizes the importance of the problem of closeness for their functioning. Particular attention is paid to the positioning of state institutions in networks, the author reveals the reasons for their use of a predominantly principal-agent mechanism for coordinating interaction with nongovernment participants, which reduces the degree of their freedom in the network, but at the same time guarantees the observance of socially significant interest in the implementation of programs and projects. The article also discusses in detail the configurations of networks and the specifics of their activities at all stages of decision-making and implementation, emphasizes the opportunities and threats associated with the activities of certain types of network alliances. The author emphasizes that the negative potential of network structures is manifested in a situation of divergence of political and managerial orientations of power and society's expectations against the background of weak institutions and lack of public control over political players, which leads to the gradual replacement of public administration by the rule of latent network groups.

Characteristics and reoperation rates of paediatric tarsal coalitions: a population-based study.

PurposeTarsal coalitions are congenital fusions of two or more tarsal bones and can lead to foot pain and stiffness. Few studies examine the long-term reoperation rates following paediatric tarsal coalition surgery.MethodsA population-based database, linking medical records at all medical centres to capture the entire medical history of the full population of a Midwest county, was used to identify tarsal coalitions in children between 1966 and 2018. Records were reviewed for clinical data, surgical records and followed up to identify any subsequent surgical interventions.ResultsA total of 58 patients (85 coalitions) were identified; 46 calcaneonavicular (CN) coalitions, 30 talocalcaneal (TC) coalitions and nine other coalitions (seven talonavicular, one naviculocuboid, one naviculocuneiform). In all, 46 coalitions were treated surgically (43 coalition resections, three arthrodeses) and 39 were treated nonoperatively. Patients treated surgically were less likely to report ongoing symptoms at final follow-up compared with patients managed nonoperatively (33% versus 67%; p = 0.0017). With a median 14.4 years (interquartile range 9.3 to 19.7) follow-up, there was an overall re-operation rate of 8.7% (4/46). Differences in reoperation rates by initial surgery (resection versus arthrodesis; p = 0.2936), coalition type (CN versus TC versus Other; p = 0.6487) or composition (osseous versus fibrocartilaginous; p = 0.29) did not reach statistical significance.ConclusionThis is the first population-based study demonstrating the durability of surgical management of tarsal coalitions in a paediatric population. At final follow-up, patients treated surgically are less likely to report persistent symptoms compared with patients managed nonoperatively. Long-term reoperation rates appear to be low (8.7%).Level of evidence:III

Incidence of Symptomatic Pediatric Tarsal Coalition in Olmsted County: A Population-Based Study.

Tarsal coalitions are an important reason for foot pain in children. Early estimates placed the prevalence at up to 2%, while more recent data suggest that it is as high as 11% to 13%. To our knowledge, there have been no population-based studies to determine the true incidence of symptomatic tarsal coalitions in a pediatric population. A population-based database was used to identify all new diagnoses of symptomatic tarsal coalitions in children 18 years old or younger between 1966 and 2018. Patient records were reviewed for clinical data, and comparisons were made between the types and characteristics of the coalitions identified to determine differences in the affected populations. The annual age-specific, sex-specific, and type-specific incidence rates were estimated. During the study period, 58 patients with a total of 79 symptomatic tarsal coalitions were identified (annual incidence = 3.5 per 100,000 children). There were 43 calcaneonavicular (CN) coalitions (annual incidence = 1.9 per 100,000 children), 27 talocalcaneal (TC) coalitions (annual incidence = 1.2 per 100,000 children), as well as 9 other coalitions (7 talonavicular, 1 naviculocuboid, and 1 naviculocuneiform) (annual incidence = 0.4 per 100,000 children). The overall incidence peaked between the ages of 10 and 14 years for both boys and girls (8.1 per 100,000 and 7.4 per 100,000 children, respectively). Statistical differences were identified between the types of tarsal coalitions. TC coalitions present at an older age relative to CN and other coalitions (mean,13.9, 12.7, and 11.4 years, respectively; p = 0.02). While CN and TC coalitions were similar in composition (23% and 30%, respectively, were osseous as opposed to fibrocartilaginous), other coalitions were more likely to be osseous (78%) (p = 0.0035). Other coalitions were also less likely to require surgery than CN and TC coalitions (11%, 74%, and 56%, respectively; p = 0.0015). This population-based study demonstrates differences in the clinical presentation of tarsal coalitions and provides an estimate of the true incidence of symptomatic tarsal coalitions in a pediatric population.