LIMITED OPERATIONS AND Ilizarov TECHNIQUE FOR CORRECTION OF CONGENITAL CLUBFOOT IN ADOLESCENTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QIN Sihe , GUO Baofeng , REN Longxi , ZHENG Xuejian , JIAO Shaofeng.

Department of Orthopedic Surgery, Beijing Chuiyangliu Hospital, Beijing, 100022, P.R.China.;

Corresponding author：

Keywords：

Congenital clubfoot ，Ilizarov technique ，Limited operation， Adolescent

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【Abstract】 Objective To observe the effectiveness of limited operations and Ilizarov techniques for correction of congenital clubfoot (CCF) in adolescents, and to explore the new methods and new ideas for functional reconstruction of CCF. Methods Between September 2003 and July 2010, 25 adolescent patients (40 feet) with CCF were treated. Of the 25 patients, 14 were male (20 feet) and 11 were female (20 feet) with an age range from 12 to 25 years (mean, 15.7 years). The left feet were involved in 4 cases, the right feet in 6 cases, and both feet in 15 cases. According to Qin’s clubfoot deformity scale, 9 feet were rated as degree I, 17 feet as degree II, and 14 feet as degree III. In these cases, 9 feet were accompanied by internal rotation deformities of crus and 1 case by subluxation of right hip joint. After soft tissue release and osteotomy, 9 feet (degree I) were fixed by composite external fixation instruments, 31 feet by Ilizarov external fixation instruments. The deformity was corrected from 5 to 7 days after operation with distraction of 0.5-1.0 mm/d, then distraction stopped when the ankle was corrected at a hyperextension of 5 to 10° and light valgus. The affected limb might undergo weight bearing walking with external fixation at corrected position for 4 to 6 weeks. If one had both feet deformity, staged operation should be performed with a surgery interval of 3 to 6 months (mean, 4 months). Results The fixation time was 6-12 weeks (mean, 8 weeks) in 9 feet fixed by composite external fixation instruments, and it was 6-17 weeks (mean, 13 weeks) in 31 feet fixed by Ilizarov external fixation. All 25 patients were followed up 8 months to 6 years with an average of 37 months. During distraction process, slight pin track infection occurred in 6 cases (6 feet), which were cured after expectant management. One patient had recurrence of the deformity at 2 years postoperatively, who obtained satisfactory correction after Ilizarov external fixation for 4 weeks. The satisfactory correction and foot function were achieved in the other feet with walking on full weight-bearing. According to International Clubfoot Study Group (ICFSG) score, the results were excellent in 28 feet, good in 10 feet, and fair in 2 feet, with an excellent and good rate of 95% at last follow-up. Conclusion Combined limited operation with Ilizarov technique for correcting adolescent CCF is accord with biology principle and minimally invasive surgical principle, so it is a safe，minimally invasive, and effective method. It also can broaden the operative indications and correct degree III talipes equinovarus which is unattainable by traditional orthopedic surgery.

Citation： QIN Sihe,GUO Baofeng,REN Longxi,ZHENG Xuejian,JIAO Shaofeng.. LIMITED OPERATIONS AND Ilizarov TECHNIQUE FOR CORRECTION OF CONGENITAL CLUBFOOT IN ADOLESCENTS. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(1): 31-35. doi: Copy

1.	deformity and patient reported outcome. Acta Orthop Suppl, 2010, 81(339): 1-25.
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3.	talipes equinovarus correction. Ir Med J, 2010, 103(6): 166-167.
4.	Angle Orthod, 2004, 74(1): 3-15.
5.	Clubfoot Study Group evaluation of treated clubfoot: assessment of interobserver and intraobserver reliability. J Pediatr Orthop B, 2006, 15(1): 34-36.
6.	of resistant clubfoot: is it an effective solution? J Pediatr Orthop, 2006, 26(4): 432-437.
7.	clubfoot using a simple Ilizarov frame. Int Orthop, 2004, 28(3): 183-186．.
8.	Colaço HB, Patel S, Lee MH, et al. Congenital clubfoot: a review. Br J Hosp Med (Lond), 2010, 71(4): 200-205.
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11.	Haene RA, Stephens MM. Ignacio Poseti and the Ponseti Method of congenital.
12.	David MG. Simultaneous correction of congenital vertical talus and talipes equinovarus using the ponseti method. J Foot Ankle Surg, 2011, 5(4): 494-497.
13.	秦泗河, 陈建文, 郑学建, 等. Ilizarov张力-应力法则结合三关节有限截骨矫正成年人重度马蹄内翻足. 中华骨科杂志, 2004, 24(6): 338-341.
14.	Prem H, Zenios M, Farrell R, et al. Soft tissue Ilizarov correction of congenital talipes equinovarus—5 to 10 years postsurgery. J Pediatr Orthop, 2007, 27(2): 220-224.
15.	Ferreira RC, Costa MT, Frizzo GG, et al. Correction of severe recurrent clubfoot using a simplified setting of the Ilizarov device. Foot Ankle Int, 2007, 28(5): 557-568．.
16.	Frost HM. A 2003 update of bone physiology and Wolff ’s law for clinicians.
17.	Celebi L, Muratli HH, Aksahin E, et al. Bensahel et al. and International.
18.	Alvarez C, De Vera M, Varghese R. Review of current methods used in the treatment of clubfoot at initial presentation and at recurrence. J Surg Orthop Adv, 2008, 17(2): 107-114．.
19.	Brodsky JW. The adult sequelae of treated congenital clubfoot. Foot Ankle Clin, 2010, 15(2): 287-296.
20.	Clarke NM, Uglow MG, Valentine KM. Comparison of Ponseti versus surgical treatment in congenital talipes equinovarus. J Foot Ankle Surg, 2011, 50(5): 529-534.
21.	Lampasi M, Bettuzzi C, Palmonari M, et al. Transfer of the tendon of tibialis anterior in relapsed congenital clubfoot: long-term results in 38 feet. J Bone Joint Surg (Br), 2010, 92(2): 277-283.
22.	Freedman JA, Watts H, Otsuka NY. The Ilizarov method for the treatment.
23.	El Barbary H, Abdel Ghani H, Hegazy M. Correction of relapsed or neglected.
24.	秦泗河, 夏和桃, 蔡刚, 等. Ilizarov技术矫正合并皮肤瘢痕挛缩的僵硬型足踝畸形. 中华创伤骨科杂志, 2007, 9(12): 1106-1110．.
25.	陈建文, 秦泗河, 焦绍锋, 等. 关节牵伸器及Ilizarov技术矫治小腿肌挛缩致膝踝关节畸形. 中国组织工程研究与临床康复, 2008, 12(39): 7636-7640．.

1. deformity and patient reported outcome. Acta Orthop Suppl, 2010, 81(339): 1-25.
2. Orthopade, 2010, 39 (11): 1071-1086.
3. talipes equinovarus correction. Ir Med J, 2010, 103(6): 166-167.
4. Angle Orthod, 2004, 74(1): 3-15.
5. Clubfoot Study Group evaluation of treated clubfoot: assessment of interobserver and intraobserver reliability. J Pediatr Orthop B, 2006, 15(1): 34-36.
6. of resistant clubfoot: is it an effective solution? J Pediatr Orthop, 2006, 26(4): 432-437.
7. clubfoot using a simple Ilizarov frame. Int Orthop, 2004, 28(3): 183-186．.
8. Colaço HB, Patel S, Lee MH, et al. Congenital clubfoot: a review. Br J Hosp Med (Lond), 2010, 71(4): 200-205.
9. Wallander HM. Congenital clubfoot. Aspects on epidemiology, residual.
10. Weimann-Stahlschmidt K, Krauspe R, Westhoff B. Congenital clubfoot.
11. Haene RA, Stephens MM. Ignacio Poseti and the Ponseti Method of congenital.
12. David MG. Simultaneous correction of congenital vertical talus and talipes equinovarus using the ponseti method. J Foot Ankle Surg, 2011, 5(4): 494-497.
13. 秦泗河, 陈建文, 郑学建, 等. Ilizarov张力-应力法则结合三关节有限截骨矫正成年人重度马蹄内翻足. 中华骨科杂志, 2004, 24(6): 338-341.
14. Prem H, Zenios M, Farrell R, et al. Soft tissue Ilizarov correction of congenital talipes equinovarus—5 to 10 years postsurgery. J Pediatr Orthop, 2007, 27(2): 220-224.
15. Ferreira RC, Costa MT, Frizzo GG, et al. Correction of severe recurrent clubfoot using a simplified setting of the Ilizarov device. Foot Ankle Int, 2007, 28(5): 557-568．.
16. Frost HM. A 2003 update of bone physiology and Wolff ’s law for clinicians.
17. Celebi L, Muratli HH, Aksahin E, et al. Bensahel et al. and International.
18. Alvarez C, De Vera M, Varghese R. Review of current methods used in the treatment of clubfoot at initial presentation and at recurrence. J Surg Orthop Adv, 2008, 17(2): 107-114．.
19. Brodsky JW. The adult sequelae of treated congenital clubfoot. Foot Ankle Clin, 2010, 15(2): 287-296.
20. Clarke NM, Uglow MG, Valentine KM. Comparison of Ponseti versus surgical treatment in congenital talipes equinovarus. J Foot Ankle Surg, 2011, 50(5): 529-534.
21. Lampasi M, Bettuzzi C, Palmonari M, et al. Transfer of the tendon of tibialis anterior in relapsed congenital clubfoot: long-term results in 38 feet. J Bone Joint Surg (Br), 2010, 92(2): 277-283.
22. Freedman JA, Watts H, Otsuka NY. The Ilizarov method for the treatment.
23. El Barbary H, Abdel Ghani H, Hegazy M. Correction of relapsed or neglected.
24. 秦泗河, 夏和桃, 蔡刚, 等. Ilizarov技术矫正合并皮肤瘢痕挛缩的僵硬型足踝畸形. 中华创伤骨科杂志, 2007, 9(12): 1106-1110．.
25. 陈建文, 秦泗河, 焦绍锋, 等. 关节牵伸器及Ilizarov技术矫治小腿肌挛缩致膝踝关节畸形. 中国组织工程研究与临床康复, 2008, 12(39): 7636-7640．.

Chinese Journal of Reparative and Reconstructive Surgery

LIMITED OPERATIONS AND Ilizarov TECHNIQUE FOR CORRECTION OF CONGENITAL CLUBFOOT IN ADOLESCENTS

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