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Relapsed clubfoot correction with soft-tissue release and selective application of Ilizarov technique.

Malizos KN, Gougoulias NE, Dailiana ZH, Rigopoulos N, Moraitis T - Strategies Trauma Limb Reconstr (2008)

Bottom Line: Postoperative radiographic measurements revealed values that can be considered as normal.Complications included pin tract infections (12% of inserted wires).Flat-topped talus was observed in 3 feet.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, University of Thessalia, 22 Papakiriazi St, 41222, Larissa, Greece, malizos@med.uth.gr.

ABSTRACT
The Ilizarov technique is an alternative for the treatment of complex foot deformities in children. The authors retrospectively reviewed children with relapsed clubfoot deformity, treated with soft tissue procedures and additional correction with an Ilizarov frame. Twelve consecutive patients (13 feet) with relapsed clubfoot deformity after previous surgical correction were reviewed. Treatment included open releases. An Ilizarov frame was applied as an adjunct in seven patients (mean age of 7.8 years) with severe deformity where complete intraoperative correction was not achieved. Clinical and radiographic assessment was undertaken. The mean Laaveg-Ponseti score, for the 7 feet treated with the Ilizarov frame, was 85.1 after minimum 4 years follow-up. One recurrence of forefoot deformity required metatarsal osteotomies. Postoperative radiographic measurements revealed values that can be considered as normal. Complications included pin tract infections (12% of inserted wires). Flat-topped talus was observed in 3 feet. Deformity correction was possible when soft tissue procedures were combined with the use of Ilizarov technique, in order to support and gradually improve surgical correction.

No MeSH data available.


Related in: MedlinePlus

The Ilizarov frame (Smith and Nephew, Memphis, Tennessee) consisted of two tibial rings, a half ring placed posterior and fixed on to the calcaneus and a midfoot transfixion half-ring. Hinges placed appropriately allowed gradual correction
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Fig1: The Ilizarov frame (Smith and Nephew, Memphis, Tennessee) consisted of two tibial rings, a half ring placed posterior and fixed on to the calcaneus and a midfoot transfixion half-ring. Hinges placed appropriately allowed gradual correction

Mentions: The frame consisted of two tibial rings and a half ring placed posterior and fixed on to the calcaneus (Fig. 1). Another half-ring for transfixion of the anterior and midfoot completed the frame configuration. Crossed 1.5 mm wires tensioned at 70 kg, were used to fix the rings. The tibial rings were placed in the mid- and distal tibia with either half-pins or tensioned wires. A hinged construct was used for equinus correction, as reported also by other authors [18]. Distractors connected the calcaneal and tibial rings to allow for correction of equinus and varus sequentially (Fig. 1). The midfoot ring distractors were positioned so that the equinus, supination, and adduction could be corrected. Additional distractors, placed medially and laterally between the metatarsal and calcaneal half-rings, were applied to correct residual cavus. The hindfoot deformity was corrected by lengthening the two rods connecting the tibial segment to the hindfoot fixator segment. The medial rod was lengthened faster than the lateral one to obtain simultaneous correction of the varus deformity. Adduction and cavus deformities of the midfoot and forefoot were corrected by lengthening the rods that connected the hindfoot to the forefoot. Equinus deformity was the last to be corrected. Distraction and gradual correction started 2 days following surgery and lasted until some overcorrection was obtained. Normal weight bearing mobilization was allowed at the child’s tolerance, when a plantigrade foot was achieved. The frame remained in situ for 9–12 weeks depending on the severity of the deformity and the degree of stiffness. The frame was then removed under sedation anesthesia and a below knee walking cast was applied for 6 weeks. Night splints were used thereafter for 6 months. In the other subset of 6 feet, the K-wires were removed in the eighth week followed by application of a walking cast (6 weeks). Night splints were used thereafter for 6 months.Fig. 1


Relapsed clubfoot correction with soft-tissue release and selective application of Ilizarov technique.

Malizos KN, Gougoulias NE, Dailiana ZH, Rigopoulos N, Moraitis T - Strategies Trauma Limb Reconstr (2008)

The Ilizarov frame (Smith and Nephew, Memphis, Tennessee) consisted of two tibial rings, a half ring placed posterior and fixed on to the calcaneus and a midfoot transfixion half-ring. Hinges placed appropriately allowed gradual correction
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2599798&req=5

Fig1: The Ilizarov frame (Smith and Nephew, Memphis, Tennessee) consisted of two tibial rings, a half ring placed posterior and fixed on to the calcaneus and a midfoot transfixion half-ring. Hinges placed appropriately allowed gradual correction
Mentions: The frame consisted of two tibial rings and a half ring placed posterior and fixed on to the calcaneus (Fig. 1). Another half-ring for transfixion of the anterior and midfoot completed the frame configuration. Crossed 1.5 mm wires tensioned at 70 kg, were used to fix the rings. The tibial rings were placed in the mid- and distal tibia with either half-pins or tensioned wires. A hinged construct was used for equinus correction, as reported also by other authors [18]. Distractors connected the calcaneal and tibial rings to allow for correction of equinus and varus sequentially (Fig. 1). The midfoot ring distractors were positioned so that the equinus, supination, and adduction could be corrected. Additional distractors, placed medially and laterally between the metatarsal and calcaneal half-rings, were applied to correct residual cavus. The hindfoot deformity was corrected by lengthening the two rods connecting the tibial segment to the hindfoot fixator segment. The medial rod was lengthened faster than the lateral one to obtain simultaneous correction of the varus deformity. Adduction and cavus deformities of the midfoot and forefoot were corrected by lengthening the rods that connected the hindfoot to the forefoot. Equinus deformity was the last to be corrected. Distraction and gradual correction started 2 days following surgery and lasted until some overcorrection was obtained. Normal weight bearing mobilization was allowed at the child’s tolerance, when a plantigrade foot was achieved. The frame remained in situ for 9–12 weeks depending on the severity of the deformity and the degree of stiffness. The frame was then removed under sedation anesthesia and a below knee walking cast was applied for 6 weeks. Night splints were used thereafter for 6 months. In the other subset of 6 feet, the K-wires were removed in the eighth week followed by application of a walking cast (6 weeks). Night splints were used thereafter for 6 months.Fig. 1

Bottom Line: Postoperative radiographic measurements revealed values that can be considered as normal.Complications included pin tract infections (12% of inserted wires).Flat-topped talus was observed in 3 feet.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, University of Thessalia, 22 Papakiriazi St, 41222, Larissa, Greece, malizos@med.uth.gr.

ABSTRACT
The Ilizarov technique is an alternative for the treatment of complex foot deformities in children. The authors retrospectively reviewed children with relapsed clubfoot deformity, treated with soft tissue procedures and additional correction with an Ilizarov frame. Twelve consecutive patients (13 feet) with relapsed clubfoot deformity after previous surgical correction were reviewed. Treatment included open releases. An Ilizarov frame was applied as an adjunct in seven patients (mean age of 7.8 years) with severe deformity where complete intraoperative correction was not achieved. Clinical and radiographic assessment was undertaken. The mean Laaveg-Ponseti score, for the 7 feet treated with the Ilizarov frame, was 85.1 after minimum 4 years follow-up. One recurrence of forefoot deformity required metatarsal osteotomies. Postoperative radiographic measurements revealed values that can be considered as normal. Complications included pin tract infections (12% of inserted wires). Flat-topped talus was observed in 3 feet. Deformity correction was possible when soft tissue procedures were combined with the use of Ilizarov technique, in order to support and gradually improve surgical correction.

No MeSH data available.


Related in: MedlinePlus