Predictive ability of scoring systems towards casting in treatment of idiopathic clubfoot by the Ponseti method in infants

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Abhishek Jain ◽  
Parmanand Gupta ◽  
Siddharth Kothari ◽  
Vikas Bachhal
Keyword(s):  
Predictive Ability ◽  
Scoring Systems ◽  
Ponseti Method ◽  
Idiopathic Clubfoot

scholarly journals Interobserver reliability of Diméglio and Pirani score and their subcomponents in the evaluation of idiopathic clubfoot in a clinical setting: a need for improved scoring systems

2019 ◽  
Vol 13 (5) ◽  
pp. 478-485
Author(s):  
C. Bettuzzi ◽  
C. N. Abati ◽  
G. Salvatori ◽  
A. Zanardi ◽  
M. Lampasi
Keyword(s):  
Clinical Setting ◽  
Interobserver Reliability ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Scoring Systems ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Level Of Evidence ◽  
Prevalence Index ◽  
Level I

Purpose Diméglio (DimS) and Pirani (PirS) scores are the most commonly used scoring systems for evaluation of clubfoot, with many centres performing both. Interobserver reliability of their global score has been rated high in a few studies, but agreement of their subcomponents has been poorly investigated. The aim of the study was to assess interrater reliability of global scores and of items in a clinical setting and to analyse overlapping features of the two scores. Methods Fifty-six consecutive idiopathic clubfeet undergoing correction using the Ponseti method were independently evaluated at each casting session by two trained paediatric orthopaedic surgeons using both scores. Interobserver reliability of collected data was analysed; a kappa coefficient > 0.60 was considered adequate. Results For DimS and PirS, the Pearson correlation coefficients were 0.87 and 0.91 (p < .0001) respectively, and kappa coefficients were 0.23 and 0.31. Among subcomponents, kappa values were rated > 0.60 only for equinus and curvature of lateral border in PirS; muscular abnormality in DimS was rated 0.74 but a high prevalence index (0.94) indicated influence of scarce prevalence of this feature. All other items showed k < 0.60 and were considered to be improved. For overlapping features: posterior and medial crease showed similar agreement in the two systems, items describing equinus and midfoot adduction were much more reliable in PirS than in DimS. Conclusions In a clinical setting, despite a high correlation of evaluations for total scores, the interobserver agreement of DimS and PirS was not adequate and only a few items were substantially reliable. Simultaneous use of two scores seemed redundant and some overlapping features showed different reliability according to criterion or scale used. Future scoring systems should improve these limitations. Level of Evidence Level I – Diagnostic studies

scholarly journals Can clubfoot scoring systems predict the number of casts and future recurrences in patients undergoing Ponseti method?

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Mohammad Ali Tahririan ◽  
Mohammadreza Piri Ardakani ◽  
Sara Kheiri
Keyword(s):  
English Literature ◽  
Scoring Systems ◽  
Ponseti Method ◽  
Term Treatment ◽  
Classification Systems ◽  
Idiopathic Clubfoot ◽  
Short Term Treatment ◽  
Pirani Score ◽  
Treatment Parameter ◽  
The Mean

Abstract Background Congenital clubfoot is one of the common congenital orthopaedic deformities. Pirani and Dimeglio scoring systems are two classification systems for measuring the severity of the clubfoot. However, the relation between the initial amount of each of these scores and the treatment parameters is controversial. Methods Patients with severe and very severe idiopathic clubfoot undergoing Ponseti treatment were entered. Their initial Pirani and Dimeglio scores, the number of castings as a short-term treatment parameter, and the recurrences as a long-term parameter until the age of three were prospectively documented. Results One hundred patients (143 feet) with mean age of 9.51 ± 2.3 days including 68 males and 32 females and the mean initial Pirani score of 5.5 ± 0.5 and the mean initial Dimeglio score of 17.1 ± 1.6 were studied. The incidence of relapse was 8.4 %( n = 12). The mean initial Pirani score (P < 0.001) and the mean initial Dimeglio score (P < 0.003) of the feet with recurrence were significantly more than the non-recurrence feet. The mean number of casts in the recurrence group (7 ± 0.9) was significantly more than the feet without recurrences (6.01 ± 1.04) (P = 0.002). The ROC curve suggested the Pirani score of 5.75 and the Dimeglio score of 17.5 as the cut-off points of these scores for recurrence prediction. Conclusion In our study, Pirani and Dimeglio scores are markedly related with more number of casts and recurrence in patients with severe and very severe clubfoot. Also, we have introduced new cut-off points for both classification systems for prediction of recurrence. To the best of our knowledge, this finding has not been introduced into the English literature.

scholarly journals Rational selection of treatment methods in recurrent clubfoot

2021 ◽  
pp. 64-71
Author(s):  
G. V. Divovich
Keyword(s):  
Surgical Treatment ◽  
Bone Growth ◽  
Soft Tissues ◽  
Primary Treatment ◽  
Ponseti Method ◽  
Growth Potential ◽  
Idiopathic Clubfoot ◽  
Rational Selection ◽  
Congenital Clubfoot ◽  
Selection Of

Objective. Based on an analytical assessment of the results of surgical treatment of children with equinovarus foot deformity of various origins (idiopathic clubfoot, syndromic clubfoot), to determine a way of rational selection of surgical techniquesin each specifc case.Materials and methods. The results of the treatment of 78 children with congenital idiopathic clubfoot over the period 2010–2018 were assessed in comparison with the results of the treatment of 41 children with recurrent congenital clubfoot, whose primary treatment had been carried out before 2010. We have gained the experience in treating 30 children with severe clubfoot syndrome (meningomyelocele, CNS lesions, chromosomal diseases and others).Results. In the treatment of congenital clubfoot with the Ponseti method, recurrences occur in 21.79 % of the cases, and in the traditional treatment — in 57.74 %. The Ponseti surgical treatment of recurrences consists in performing release operations on the tendon-ligament apparatus from mini-accesses. Cases of rigid, long-standing deformities require extensive releases on soft tissues, as well as resection and arthrodesis interventions on the joints of the foot. The treatment of clubfoot syndrome requires “surgically aggressive” methods of correction in early childhood.Conclusion. In the idiopathic variants of clubfoot and its relapses, it is possible to correct the vicious position of the feet by minimally invasive operations with minimal damage to the tissues of the circumflex joints and without damage to the flexor tendons and their sheaths in the medial ankle area. Long-standing recurrent rigid variants, as well as syndromic clubfoot, presuppose the performance of extensive releases, osteotomies and arthrodetic resections of the joints of the foot at an early age. A promising direction for clubfoot correction in the process of child development is a surgery with the use of the bone growth potential of the lower leg and foot.

scholarly journals RESULTS OF TREATMENT OF IDIOPATHIC CONGENITAL CLUBFOOT IN CHILDREN: A 3-YEAR FOLLOW UP STUDY

2020 ◽  
Vol 73 (12) ◽  
pp. 2640-2643
Author(s):  
Oleksii O. Holubenko ◽  
Anatolii F. Levytskyi ◽  
Oleksandr V. Karabenyuk
Keyword(s):  
Soft Tissue ◽  
Recurrence Rate ◽  
Primary Treatment ◽  
Nonparametric Tests ◽  
Ponseti Method ◽  
Soft Tissue Release ◽  
Idiopathic Clubfoot ◽  
Results Of Treatment ◽  
Pirani Score ◽  
Serial Casting

The aim: Was to analyze the outcome, recurrence rate and complications between Ponseti method and soft-tissue release 3 yearsafter the initial treatment. Materials and methods: This prospective cohort study was conducted in congenital idiopathic clubfoot patients who underwent primary treatment by either Ponseti serial casting or soft tissue release between 2006 to 2016 at department of traumatology and orthopedics National Children’s Specialized Hospital “Okhmatdet”. Total of 113 feet in 95 patients (61 males and 34 females), sixty-two feet (62 patients) were in the Ponseti group and thirty-three feet (33 patients) were in the surgical treatment group. For both groups, descriptive statistics were calculated Pirani score (2004) result before and 3 years after treatment, recurrence rate and complications. The comparison of the Pirani score result and complications between the two groups was analyzed by nonparametric tests (Mann-Whitney U-tests). Statistical data processing was performed in SPSS 17.0 program. Results: The results of Pirani score reveal satisfactory outcomes for both groups. But Ponseti method has the more conservative approach and lower complication rate (11,29±5,27% and 24,24±11,74%, p=0,52). Conclusions: Ponseti method is a safe, effective method for treatment of congenital idiopathic clubfoot in children from first days after birth. Open surgery should be reserved for deformity that cannot be completely corrected or for treatment of recurrences.

scholarly journals Validation of Predictive Ability of Bobi Score in Burn Patients

2021 ◽  
Vol 6 (4) ◽  
Keyword(s):  
Burn Injury ◽  
Prognostic Score ◽  
Area Under The Curve ◽  
Predictive Ability ◽  
Scoring Systems ◽  
Good Prediction ◽  
Burn Patients ◽  
Severe Burns ◽  
Inhalation Burn ◽  
Outstanding Result

Introduction: Scoring systems have been used successfully in burn centers to predict the prognosis and take measures for careful monitoring of the burned patient. Belgium Outcome Burn Injury score is one of them which takes into consideration age, burn surface area, and presence of inhalation burn. Objectives: This presentation aims to validate the use of the BOBI prognostic score in our patients. Patients and Methods: The study is a retrospective analytical study that utilized the investigation of the medical charts of 1515 patients hospitalized with severe burns within the ICU of the Service of Burns in Tirana, Albania during 2010-2019. Results: The overall mortality of our patients was 7.06% (107 deaths in 1515 patients). Up to BOBI score 6, we have noticed better mortality than prediction while there is a very good prediction up to score 10. Area Under the Curve was 0.978 (p<0.0001) which is an outstanding result in being a classifier between deaths and survivors. Conclusions: BOBI score is a very good prediction score for mortality in burn patients.

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