Treatment of Residual Clubfoot Deformities with the Treatm ... · Treatment of Residual Clubfoot...
Transcript of Treatment of Residual Clubfoot Deformities with the Treatm ... · Treatment of Residual Clubfoot...
Results Mean time in frame: 3.6 months (range, 3–8 months) 1 patient had residual equinus All other patients achieved full correction of deformities
Complications 9 Superficial pin site infections (treated with oral antibiotics) 1 Talar subluxation (reduced using the residual TSF program) 2 First metatarsophalangeal joint subluxations (corrected by pinning in a separate surgery in both cases)
Conclusions Ponseti sequence of correction with the TSF is a viable alternative for older children with previously operated club feet. Safe Minimally invasive surgery (minimizes scarring) Accurate (computer-based) Allows for subsequent treatment if needed
Residual Clubfoot Problems Supination Hindfoot varus Cavus Forefoot adductus Internal spin of foot
Clinical Review (2002–2006) 17 Patients (22 feet) 8 Baltimore, MD, USA 5 Haifa, Israel 4 Afula, Israel
Taylor Spatial Frame Computer-based technology Six-axis deformity correction Most accurate external fixator available
Etiology 9 Idiopathic talipes equinovarus (TEV) 5 Arthrogryposis 1 Spina bifida 1 Developmental clubfoot 1 Fibular hemimelia TEV
Demographics Mean age: 6.5 years (range, 1.8–15 years) 8 Boys / 9 girls 11 Ponsetaylor Type I Frame 6 Ponsetaylor Type II Frame
Treatment All patients underwent correction with standard two-ring frames using a long bone program.
Methods We propose an alternate treatment method using the Taylor spatial frame (TSF) and Ponseti principles. We call this combination the Ponsetaylor technique. The Ponsetaylor type I frame is programmed to first correct varus and internal rotation and then equinus. The Ponsetaylor type II frame follows the same sequence but includes a final phase in which the foot ring is cut for correction of forefoot cavus and adductus.
TreatmTreatment of Residual Clubfoot Deformities with the Taylor Spatial Frame Using a Ponseti Sequence
Origin
4
315
6
7
2
Beforetreatment
Postoperative
Aftertreatment
Stirrup wirethrough distal
tibial epiphysisto prevent
growth plateseparation
Initial frame:before finalmodificationto foot ring
TSF strutsattached
Talar wireremoved fromtibial ring and
attached tofoot frame in
preparation forankle equinus
correction(allows talusto dorsiflex)
Stage 1correctioncompleted
Lateral olive wirethrough talus and attached to tibial ringto block talar rotation
Talocalcanealangle = 15°
Talocalcanealangle = 15°
Before Casting After Casting
Talar-1st metatarsalangle = 20°
Talar-1stmetatarsalangle = 0° TSF
Stage 1
CastingStage
TSFStage 2
2–4 weeks
2–4 weeks
2–4 weeks
2 Correct internal rotation 3 Correct hindfoot varus4 Partially correct equinus5 Distract subtalar joint
6 Modify frame7 Correct remaining equinus plus slight overcorrection
Ponsetaylor Type I Frame: Order of Correction
Same as Ponsetaylor type I except for one additional stage:correction of cavus and forefoot adductus.
TSF Stage 1
Casting Stage
Foot ring cut on both sides to allowcorrection of forefootadduction and cavuswith Ilizarov components
TSF Stage 2
15°
Before Stage 2 correctionFrame modified
20°
Equinus deformity overcorrected 20°Tibiotalar joint distracted andequinus corrected
1 Correct adduction of forefoot
Ponsetaylor Type II Frame
Mark Eidelman, MD, Alexander Katzman, MD, Noam Bor, MD, Bradley M. Lamm, DPM, Dror Paley, MD, and John E. Herzenberg, MDMark Eidelman, MD, Alexander Katzman, MD, Noam Bor, MD, Bradley M. Lamm, DPM, Dror Paley, MD, and John E. Herzenberg, MDIntroduction Correction of relapses after open clubfoot surgery is challenging. Repeat open surgery leads to more scarring and stiffness.
The Ilizarov frame has been used to treat such cases. However, it does not control rotation well.