EVALUATION OF RESULTS OF GRADUAL DISTRACTION TECHNIQUE FOR CORRECTION AND FUNCTIONAL RECOVERY OF NEGLECTED CTEV

2021 ◽  
pp. 31-33
Author(s):  
Mujibar Rahaman Mullick ◽  
Sumanta Panja
Keyword(s):  
Functional Outcome ◽  
Functional Recovery ◽  
Tertiary Care ◽  
Pressure Sore ◽  
Idiopathic Clubfoot ◽  
Tertiary Care Centre ◽  
Congenital Talipes Equinovarus ◽  
Talipes Equinovarus ◽  
Pin Tract Infection ◽  
Congenital Foot Deformity

INTRODUCTION: Congenital talipes equinovarus (CTEV) or clubfoot is commonest congenital foot deformity. The incidence of Congenital Idiopathic Clubfoot ranges from 0.36/1000 to 6.8/1000 in some populations and about 1.2/1000 births among Caucasians including Indians, with a 1 much higher occurrence in the affected families . More common in male (2:1). Bilateral cases account for about 50%. In unilateral cases right side affected more. The term talipes is derived from talus (ankle bone) and pes (foot). AIMS & OBJECTIVES:To assess the efcacy of gradual differential distraction with JESS as a method of treatment in neglected CTEV. Evaluation of functional recovery of neglected CTEVusing this technique. To assess the morbidity & complication of the technique. MATERIALS AND METHODS: Study area: - The study was institution based, conducted at the Orthopaedics department of I.P.G.M.E.R.& S.S.K.M. Hospital, Kolkata, a tertiary care centre catering to people of West Bengal and adjacent states of Eastern India Study population: Patients attending Orthopedics' O.P.D. of IPGMER & SSKM Hospital. Study period: From May 2016 to Oct 2017 (18 months duration) Sample size: 20 patients (24 feet) Sample design: Patient selection: RESULTS AND ANALYSIS: 2(8.3%) patients exion deformity of toes. 1(4.2%) Persitant cavus, 1(4.2%) had liniar skin necrosis, 1(4.2%) patients had pressure sore, 1(4.2%) had oedema of feet, 1(4.2%) persistent all deformity, 2(8.3%) patients had persistan tequinus, 5(20.8%) patients had persistant heel varus, 2(8.3%) patients had forfoot adduction, 3(12.5%) patients had pin tract infection and 11(45.8%) had no complication. 4(16.7%) patients had excellent functional outcome, 8(33.3%) patients had good functional outcome, 8(33.3%) patients had moderate functional outcome and 4(16.7%) patients had poor functional outcome. CONCLUSION: In our study 12(82.3%) feet had excellent to moderate result, only 4(16.7%) had poor result with limited complication. Few patients left with one or more persistent deformity but the nal outcome was functionally satisfactory. JESS is an excellent technique in the management of neglected cases of CTEV especially when it is done at an early age. Differential distraction by JESS xator for the correction of neglected idiopathic CTEV is an effective and patient-friendly method of management. Therefore the differential distraction with JESS can be considered as a treatment modality for the neglected CTEV.

scholarly journals A comparative study of functional outcome between posterior lumbar fusion and posterior lumbar interbody fusion in spondylolisthesis

2021 ◽  
Vol 7 (3) ◽  
pp. 544
Author(s):  
Harpreet Singh ◽  
Dhruv Patel ◽  
Sangam Tyagi ◽  
Krushna Saoji ◽  
Tilak Patel ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Interbody Fusion ◽  
Operative Time ◽  
Lumbar Fusion ◽  
Tertiary Care ◽  
Posterior Lumbar Interbody Fusion ◽  
Invasive Technique ◽  
Lumbar Interbody Fusion ◽  
Tertiary Care Centre ◽  
Posterior Lumbar Fusion

<p class="abstract"><strong>Background:</strong> Spondylolisthesis is condition in which one vertebra slips over other vertebra. This study has been done to compare the functional outcome and complications of two techniques: posterior lumbar fusion (intertransverse fusion) and posterior lumbar interbody fusion.</p><p class="abstract"><strong>Methods:</strong> Total 20 patients with spondylolisthesis admitted in a tertiary care centre in Rajasthan were allotted alternatively in posterior lumbar fusion (PLF) group and posterior lumbar interbody fusion (PLIF) group. In PLF, fusion was done by placing bone graft between transverse processes and around facets. In PLIF, fusion was bone by placing cage in between vertebral bodies.</p><p class="abstract"><strong>Results:</strong> 20 patients were included in our study with female predominance (65%). Mean age was 54.2 years (PLF=58.4 and PLIF=50.2). 70% patients have L4-L5 level spondylolisthesis. Average operative time was less in PLF group, which is statistically significant. Functional outcome was measured by using visual analogue scale (VAS) score and Japanese orthopedics association score (JOAS) at 3 weeks, 3 months and 6 months. There is a significant decrease between preoperative VAS and at 6 months, in both PLF and PLIF group. JOAS was significantly increased at 6 months in both PLF and PLIF group as compared to preoperative score. But difference in JOAS at 6 months is not significant between PLF and PLIF.</p><p class="abstract"><strong>Conclusions:</strong> Both PLF and PLIF are equally effective for spondylolisthesis. Both techniques have same satisfactory results. As PLIF is more invasive technique, more operative time and more complications are seen.</p>

MANAGEMENT OF IDIOPATHIC CONGENITAL CLUBFOOT USING PONSETI METHOD

2021 ◽  
pp. 38-39
Author(s):  
Chunchesh MD Chunchesh MD ◽  
Vani Ahuja ◽  
Kiran S Mahapure
Keyword(s):  
Cost Effective ◽  
Ponseti Method ◽  
Foot Deformities ◽  
Idiopathic Clubfoot ◽  
Congenital Talipes Equinovarus ◽  
Cost Effective Treatment ◽  
Pediatric Orthopaedics ◽  
Talipes Equinovarus ◽  
Main Factor

Introduction: Idiopathic congenital talipes equinovarus is a complex deformity that is difcult to correct. The treatment of clubfoot is controversial and continues to be one of the biggest challenges in pediatric orthopaedics. Most orthopedists agree that the initial treatment should be non-surgical and should be started soon after birth. We aimed to study a short-term follow up of 30 patients treated by the Ponseti method at our institute to assess the efcacy of the treatment modality. Methodology: 30 patients underwent Ponseti method for a period of 2 years, patients were followed up regularly at weekly intervals. The severity of foot deformities was graded as per Pirani's scoring system. Results: The Ponseti method is a safe and cost-effective treatment for congenital idiopathic clubfoot and radically decreases the need for extensive corrective surgery. Non-compliance with orthotics has been widely reported to be the main factor causing failure of the technique. At the end of study good results were obtained in 28 patients. 2 patients developed recurrence of the deformity due to non-compliance of the use of Orthotics.

scholarly journals Ponseti Treatment in the Management of Clubfoot Deformity – A Continuing Role for Paediatric Orthopaedic Services in Secondary Care Centres

2007 ◽  
Vol 89 (5) ◽  
pp. 510-512 ◽  
Author(s):  
Charles EJ Docker ◽  
Simon Lewthwaite ◽  
Nigel T Kiely
Keyword(s):  
Tertiary Care ◽  
Resource Utilisation ◽  
Tertiary Referral Centre ◽  
Congenital Talipes Equinovarus ◽  
Hub And Spoke ◽  
Surgical Interventions ◽  
Achilles Tenotomy ◽  
Talipes Equinovarus ◽  
Paediatric Orthopaedic ◽  
Set Up

INTRODUCTION The Ponseti technique is a well-proven way of managing paediatric clubfoot deformity. We describe a management set-up which spreads the care between secondary and tertiary care with no loss of quality. PATIENTS AND METHODS In our audit of the first 2 years of Ponseti casting in the treatment of idiopathic congenital talipes equinovarus (CTEV, clubfoot) deformity, we identified 77 feet having been treated in 50 patients. Forty-nine feet were treated primarily in Oswestry, a tertiary referral centre for paediatric orthopaedic conditions, and 13 feet were treated in conjunction with the physiotherapy department at one of the region's district general hospitals (Leighton Hospital, Crewe, Cheshire). RESULTS Similar good results and low requirement for surgical interventions other than Achilles tenotomy, which forms part of the Ponseti regimen, were found in both cohorts. CONCLUSIONS This ‘hub-and-spoke’ approach would appear to be efficient in terms of resource utilisation. Additional benefits atients and their carers include ease of access to services and reduced financial and transport burdens.

scholarly journals Management of idiopathic clubfoot with Ponseti technique

2017 ◽  
Vol 5 (8) ◽  
pp. 3355 ◽  
Author(s):  
Sumeet Singh Charak ◽  
Khalid Muzafar ◽  
Omeshwar Singh
Keyword(s):  
Effective Treatment ◽  
Club Foot ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Corrective Surgery ◽  
Congenital Talipes Equinovarus ◽  
Talipes Equinovarus ◽  
The Mean ◽  
Congenital Talipes ◽  
Main Factor

Background: Idiopathic congenital talipes equinovarus (club foot) is a complex deformity that is difficult to correct. The goal of treatment is to reduce or eliminate its four components so that the patient has a functional foot and leads a normal life.Methods: Study have treated 20 patients with 32 idiopathic clubfoot deformities using Ponseti method. The severity was assessed by modified pirani scoring.Results: The mean number of casts that were applied to obtain correction was 7.02 (range four to nine casts). Tenotomy was done in 30 feet. Thirty feet had good results. One patient developed recurrence of the deformity due to non-compliance of the use of orthrotics.Conclusions: The Ponseti method is a safe and effective treatment for congenital idiopathic clubfoot and radically decreases the need for corrective surgery. Non-compliance with orthotics main factor causing failure of the technique.

scholarly journals Comparative analysis of correction of idiopathic congenital talipes equinovarus by conventional and accelerated Ponseti method with minimum 12 months follow up in a tertiary care hospital in North India

2021 ◽  
Author(s):  
Pankaj Vir Singh ◽  
Abdul Ghani ◽  
Tejpal Singh ◽  
Anzar Tariq Malik ◽  
Simranpreet Singh
Keyword(s):  
Tertiary Care ◽  
North India ◽  
Standard Group ◽  
Care Hospital ◽  
Congenital Talipes Equinovarus ◽  
Pirani Score ◽  
Talipes Equinovarus ◽  
Congenital Talipes ◽  
Accelerated Ponseti

Background: Congenital talipes equinovarus varus (CTEV) is one of the most common congenital anomalies of foot and ankle affecting 1/1000 live birth approximately. With a male dominance pattern, this deformity is bilateral in 50% cases. It has four basic components: cavus, adduction, varus and equinus. Severity of clubfoot is accessed using Pirani score (0 to 6). Insights into the basic pathoanatomy of this complex 3 dimensional deformity has helped to correct it using the method given by Ignacio Ponseti, a Spanish orthopaedician, in which serial manipulations of foot are done and weekly casts are applied, followed by a tendoachilles tenotomy in selected cases to correct the equinus component which is then followed by splintage of the feet in Steenbeek splint initially for 23 hours day for 3 months and then 12 hours a day for 3 years. The most important component of this treatment is parental counselling regarding the need for compliance with treatment which is often loophole responsible for relapse in initially corrected feet.Methods: This was a prospective study including 40 patients (61 feets) of idiopathic clubfoot with age <3 month at presentation who were randomly distributed in two groups, group 1 (accelerated Ponseti casting group) in which twice weekly casts were applied and group 2 (standard Ponseti casting group) in which weekly casts were applied. Initial Pirani score was calculated in all the patients and was rechecked and documented in every successive visit. All the patients were followed upto 12 months and there was no lost to follow up in this study.Results: The mean days of plaster duration in accelerated casting group was 18.45 days as compared to 47.25 days in standard casting group (statistically significant, p value <0.05). Also, Pirani score at the end of last follow up was comparable in both the groups. Tenotomy rate was slightly higher in accelerated casting group (89.5%) as compared to standard group (85.7%) which may be attributed to higher initial Pirani score in former (5.5) as compared to later (5.0).Conclusions: Accelerated biweekly Ponseti casting reduces the overall days of treatment with similar results compared to standard weekly casting regime.

Congenital talipes equinovarus

2019 ◽  
Vol 101-B (6) ◽  
pp. 639-645 ◽  
Author(s):  
Y. Gelfer ◽  
S. Wientroub ◽  
K. Hughes ◽  
A. Fontalis ◽  
D. M. Eastwood
Keyword(s):  
Systematic Review ◽  
Ponseti Method ◽  
Assessment Methods ◽  
Major Surgery ◽  
Idiopathic Clubfoot ◽  
Congenital Talipes Equinovarus ◽  
Talipes Equinovarus ◽  
Minor Surgery ◽  
Meta Analyses

AimsThe Ponseti method is the benchmark treatment for the correction of clubfoot. The primary rate of correction is very high, but outcome further down the treatment pathway is less predictable. Several methods of assessing severity at presentation have been reported. Classification later in the course of treatment is more challenging. This systematic review considers the outcome of the Ponseti method in terms of relapse and determines how clubfoot is assessed at presentation, correction, and relapse.Patients and MethodsA prospectively registered systematic review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that reported idiopathic clubfoot treated by the Ponseti method between 1 January 2012 and 31 May 2017 were included. The data extracted included demographics, Ponseti methodology, assessment methods, and rates of relapse and surgery.ResultsA total of 84 studies were included (7335 patients, 10 535 clubfeet). The relapse rate varied between 1.9% and 45%. The rates of relapse and major surgery (1.4% to 53.3%) and minor surgery (0.6% to 48.8%) both increased with follow-up time. There was high variability in the assessment methods used across timepoints; only 57% of the studies defined relapse. Pirani scoring was the method most often used.ConclusionRecurrence and further surgical intervention in idiopathic clubfoot increases with the duration of follow-up. The corrected and the relapsed foot are poorly defined, which contributes to variability in outcome. The results suggest that a consensus for a definition of relapse is needed. Cite this article: Bone Joint J 2019;101-B:639–645.

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