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Manipulation and brace fixing for the treatment of congenital clubfoot in newborns and infants.

Su Y, Nan G - BMC Musculoskelet Disord (2014)

Bottom Line: The mean Pirani score 1 year after treatment was 0.21 ± 0.09, whereas it was 4.93 ± 1.02 before treatment (p=0.0078).No patient required treatment with percutaneous Achilles tenotomy.This treatment can be an alternative choice to percutaneous Achilles tenotomy.

View Article: PubMed Central - PubMed

Affiliation: Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Department of Orthopaedics Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing 400014, China. ngx1215@163.com.

ABSTRACT

Background: As one of the most common congenital deformities in children, clubfoot has long been a challenge for orthopedic surgeons. This paper describes the experience of our team with manipulation and above-the-knee brace fixation without percutaneous Achilles tenotomy for the treatment of clubfoot in newborns and infants.

Methods: In the orthopedic department of our hospital, 32 infants and newborns (56 feet) with congenital clubfoot underwent manipulation and above-the-knee brace fixation between 2008 and 2012. External rotation brace was used for 1-4 years during the night after deformity correction. Prospective follow-up for a mean duration of 29 months (range, 12-48 months) was carried out. The efficacy of the treatment was assessed by Pirani's scoring system before and after treatment.

Results: Fifty-two feet achieved a normal appearance within 3 to 6 months (average, 4.2 months) after treatment. Two patients had skin pressure sores due to improper brace care, but these healed with no scarring after timely treatment. The mean Pirani score 1 year after treatment was 0.21 ± 0.09, whereas it was 4.93 ± 1.02 before treatment (p=0.0078). No patient required treatment with percutaneous Achilles tenotomy.

Conclusion: The manipulation and brace fixation used in this study offer an effective method for correcting clubfoot deformity in newborns and infants. This treatment can be an alternative choice to percutaneous Achilles tenotomy.

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Representative appearance after 1 month of manipulation treatment (Pirani score = 1.5).
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Fig4: Representative appearance after 1 month of manipulation treatment (Pirani score = 1.5).

Mentions: Patients were followed for 12–48 months with an average follow-up period of 29 months. The deformities were corrected to normal after treatment for 3–6 months (average, 4.23 months), and then fixation was started using a nighttime brace. Two patients had skin pressure sores due to improper brace care, but with no scarring occurred after timely treatment. Two patients with satisfactory results gave up nighttime brace fixation after being treated for 5 and 6 months. Deformity relapsed in one of these patients 3 months after stopping the treatment, as he had an Achilles tendon problem, and the other patient had no residual deformities at the time of last follow-up 1 year later. The mean Pirani score 1 year after treatment was 0.21 ± 0.09, which is significantly better than that before the treatment (p = 0.0078; Table 1). No patient required treatment with percutaneous Achilles tenotomy in this study. Photographs of representative cases are shown in Figures 3, 4, 5.Figure 3


Manipulation and brace fixing for the treatment of congenital clubfoot in newborns and infants.

Su Y, Nan G - BMC Musculoskelet Disord (2014)

Representative appearance after 1 month of manipulation treatment (Pirani score = 1.5).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4232732&req=5

Fig4: Representative appearance after 1 month of manipulation treatment (Pirani score = 1.5).
Mentions: Patients were followed for 12–48 months with an average follow-up period of 29 months. The deformities were corrected to normal after treatment for 3–6 months (average, 4.23 months), and then fixation was started using a nighttime brace. Two patients had skin pressure sores due to improper brace care, but with no scarring occurred after timely treatment. Two patients with satisfactory results gave up nighttime brace fixation after being treated for 5 and 6 months. Deformity relapsed in one of these patients 3 months after stopping the treatment, as he had an Achilles tendon problem, and the other patient had no residual deformities at the time of last follow-up 1 year later. The mean Pirani score 1 year after treatment was 0.21 ± 0.09, which is significantly better than that before the treatment (p = 0.0078; Table 1). No patient required treatment with percutaneous Achilles tenotomy in this study. Photographs of representative cases are shown in Figures 3, 4, 5.Figure 3

Bottom Line: The mean Pirani score 1 year after treatment was 0.21 ± 0.09, whereas it was 4.93 ± 1.02 before treatment (p=0.0078).No patient required treatment with percutaneous Achilles tenotomy.This treatment can be an alternative choice to percutaneous Achilles tenotomy.

View Article: PubMed Central - PubMed

Affiliation: Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Department of Orthopaedics Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing 400014, China. ngx1215@163.com.

ABSTRACT

Background: As one of the most common congenital deformities in children, clubfoot has long been a challenge for orthopedic surgeons. This paper describes the experience of our team with manipulation and above-the-knee brace fixation without percutaneous Achilles tenotomy for the treatment of clubfoot in newborns and infants.

Methods: In the orthopedic department of our hospital, 32 infants and newborns (56 feet) with congenital clubfoot underwent manipulation and above-the-knee brace fixation between 2008 and 2012. External rotation brace was used for 1-4 years during the night after deformity correction. Prospective follow-up for a mean duration of 29 months (range, 12-48 months) was carried out. The efficacy of the treatment was assessed by Pirani's scoring system before and after treatment.

Results: Fifty-two feet achieved a normal appearance within 3 to 6 months (average, 4.2 months) after treatment. Two patients had skin pressure sores due to improper brace care, but these healed with no scarring after timely treatment. The mean Pirani score 1 year after treatment was 0.21 ± 0.09, whereas it was 4.93 ± 1.02 before treatment (p=0.0078). No patient required treatment with percutaneous Achilles tenotomy.

Conclusion: The manipulation and brace fixation used in this study offer an effective method for correcting clubfoot deformity in newborns and infants. This treatment can be an alternative choice to percutaneous Achilles tenotomy.

Show MeSH
Related in: MedlinePlus