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Resistant clubfoot deformities managed by Ilizarov distraction histogenesis.

Makhdoom A, Qureshi PA, Jokhio MF, Siddiqui KA - Indian J Orthop (2012)

Bottom Line: At the time of removal of the fixator, a plantigrade foot was achieved in 25 feet and gait was improved in all patients.Excellent and good results (74.07%) were considered satisfactory, while fair and poor results (25.92%) were considered unsatisfactory.The short term clinical and functional results of resistant clubfoot deformities with Ilizarov's external fixator is promising and apparently a good option.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery and Traumatology (DOST), Liaquat University of Medical and Health Sciences Jamshoro, Sindh, Pakistan.

ABSTRACT

Background: Resistant clubfoot deformities of the foot and ankle remain a difficult problem even for the most experienced surgeon. We report a series of neglected resistant clubfoot deformities treated by limited surgery and Ilizarov distraction histogenesis.

Materials and methods: Twenty one patients with 27 feet having resistant clubfoot deformities were managed by Ilizarov distraction histogenesis from April 2005 to May 2008. The mean age was 12 years (range 8-20 years). A limited soft tissue dissection like percutaneous Achilles sheath tenotomy and plantar fasciotomy were done. Progressive correction of the deformities was achieved through the standard and simple Ilizarov frame construct setting. After removal of Ilizarov frame, a short leg walking cast was used for an additional 6 weeks, followed by an ankle foot orthrosis for 3 months.

Results: The mean followup period was 18.7 months (range 20-36 months). The mean duration of fixator application was 3.6 months (range 3-5 months). At the time of removal of the fixator, a plantigrade foot was achieved in 25 feet and gait was improved in all patients. There was residual varus hind foot deformity in two patients. Out of 27 feet, 3 (11.11%) were rated as excellent, 17 (62.96%) as good, 5 (18.51%) as fair, and 2 (7.40%) as poor according to Reinkerand Carpenter scale. Excellent and good results (74.07%) were considered satisfactory, while fair and poor results (25.92%) were considered unsatisfactory.

Conclusion: The short term clinical and functional results of resistant clubfoot deformities with Ilizarov's external fixator is promising and apparently a good option.

No MeSH data available.


Related in: MedlinePlus

Ilizarov frame for ankle and foot with two full rings for leg, one half for calcaneum and one half for forefoot over the metatarsals
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Figure 1: Ilizarov frame for ankle and foot with two full rings for leg, one half for calcaneum and one half for forefoot over the metatarsals

Mentions: Half ring over the calcaneus was used as a distractor or pusher and compression or pulling was achieved through the half ring over dorsum of the fore foot. Varus deformities of the heel were corrected through medial and lateral rods by compression and distraction method. These rods with hinges were applied in the rings fastened over the calcaneus and forefoot to increase or decrease the medial or lateral column according to the need of deformity correction. For correction of rotational like supination and pronation deformities, two frontal rods with hinges were applied in oblique directions connected with the ring in the forefoot and assembly over the leg and corrected accordingly. The sequence of deformities’ correction was gradual distraction of medial column and compression of lateral column to correct the forefoot adduction, 1–2 mm/day, which was started on the 2nd postoperative day. After correction of forefoot adduction supination, hind foot varus and finally equinus were corrected through the setting of the Ilizarov's external fixator. During distraction, tension over the soft tissues, neurovascular status, and improvement in the correction of the deformities were observed clinically, and radiologically dislocation or subluxation of tarsal and ankle joints was observed [Figure 1].


Resistant clubfoot deformities managed by Ilizarov distraction histogenesis.

Makhdoom A, Qureshi PA, Jokhio MF, Siddiqui KA - Indian J Orthop (2012)

Ilizarov frame for ankle and foot with two full rings for leg, one half for calcaneum and one half for forefoot over the metatarsals
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3377145&req=5

Figure 1: Ilizarov frame for ankle and foot with two full rings for leg, one half for calcaneum and one half for forefoot over the metatarsals
Mentions: Half ring over the calcaneus was used as a distractor or pusher and compression or pulling was achieved through the half ring over dorsum of the fore foot. Varus deformities of the heel were corrected through medial and lateral rods by compression and distraction method. These rods with hinges were applied in the rings fastened over the calcaneus and forefoot to increase or decrease the medial or lateral column according to the need of deformity correction. For correction of rotational like supination and pronation deformities, two frontal rods with hinges were applied in oblique directions connected with the ring in the forefoot and assembly over the leg and corrected accordingly. The sequence of deformities’ correction was gradual distraction of medial column and compression of lateral column to correct the forefoot adduction, 1–2 mm/day, which was started on the 2nd postoperative day. After correction of forefoot adduction supination, hind foot varus and finally equinus were corrected through the setting of the Ilizarov's external fixator. During distraction, tension over the soft tissues, neurovascular status, and improvement in the correction of the deformities were observed clinically, and radiologically dislocation or subluxation of tarsal and ankle joints was observed [Figure 1].

Bottom Line: At the time of removal of the fixator, a plantigrade foot was achieved in 25 feet and gait was improved in all patients.Excellent and good results (74.07%) were considered satisfactory, while fair and poor results (25.92%) were considered unsatisfactory.The short term clinical and functional results of resistant clubfoot deformities with Ilizarov's external fixator is promising and apparently a good option.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery and Traumatology (DOST), Liaquat University of Medical and Health Sciences Jamshoro, Sindh, Pakistan.

ABSTRACT

Background: Resistant clubfoot deformities of the foot and ankle remain a difficult problem even for the most experienced surgeon. We report a series of neglected resistant clubfoot deformities treated by limited surgery and Ilizarov distraction histogenesis.

Materials and methods: Twenty one patients with 27 feet having resistant clubfoot deformities were managed by Ilizarov distraction histogenesis from April 2005 to May 2008. The mean age was 12 years (range 8-20 years). A limited soft tissue dissection like percutaneous Achilles sheath tenotomy and plantar fasciotomy were done. Progressive correction of the deformities was achieved through the standard and simple Ilizarov frame construct setting. After removal of Ilizarov frame, a short leg walking cast was used for an additional 6 weeks, followed by an ankle foot orthrosis for 3 months.

Results: The mean followup period was 18.7 months (range 20-36 months). The mean duration of fixator application was 3.6 months (range 3-5 months). At the time of removal of the fixator, a plantigrade foot was achieved in 25 feet and gait was improved in all patients. There was residual varus hind foot deformity in two patients. Out of 27 feet, 3 (11.11%) were rated as excellent, 17 (62.96%) as good, 5 (18.51%) as fair, and 2 (7.40%) as poor according to Reinkerand Carpenter scale. Excellent and good results (74.07%) were considered satisfactory, while fair and poor results (25.92%) were considered unsatisfactory.

Conclusion: The short term clinical and functional results of resistant clubfoot deformities with Ilizarov's external fixator is promising and apparently a good option.

No MeSH data available.


Related in: MedlinePlus