Reconstructive surgery in recurrent deformity (clubfoot relapse)

Introduction Recurrent clubfoot deformity may be due to either an imperfect initial correction, or a natural history of a severe disease. In the later, idiopathic clubfoot is uncommon. In the review we describe reconstructive surgery in recurrent deformity of idiopathic clubfoot. Material and methods Surgery may be justified at different age and according to the type of deformity. Different surgical approaches and their indications are exposed in the article. Results After Ponseti’s method application additional surgeries may be considered in recurrent clubfoot deformity which may represent 10 to 20 % of cases: second Achilles tenotomy, postero-lateral relapse, complete antero-medial and postero-lateral relapse, transfer of the anterior tibial tendon, correction of sequelae: metatarsus varus, residual equinus, residual rotation of the calcaneopedal unit. Conclusion Idiopathic equine varus clubfoot is a frequent condition. Well-codified management should lead to extremely favorable functional results. Unfortunately, some cases lead to a recurrence of the deformity. Surgical procedures are sometimes required. The goal is to avoid as much as possible arthrodesis and secondary degenerative arthritis.

A new unilateral abduction orthosis for Ponseti-treated clubfoot: A cohort study to assess compliance

Background: The Ponseti method for treating congenital talipes equinovarus requires an orthosis to maintain correction after manipulation and casting, typically the ‘boots and bar’. Non-compliance with the orthosis increases the risk of recurrent deformity. This study investigates a new orthosis, the abduction dorsiflexion mechanism. Objectives: The aim of this study is to assess compliance of the abduction dorsiflexion mechanism when used at night and maintenance of foot morphology. Study design: This study is a cohort study. Methods: A total of 10 children with unilateral congenital talipes equinovarus previously treated with Ponseti casting were recruited to trial the abduction dorsiflexion mechanism at night for 12 weeks. Foot morphology and compliance were assessed every 4 weeks. Results: Participant families were pleased with the orthosis, opting to continue to use the device following conclusion of the trial. Compliance was good and no deterioration in Pirani score or dorsiflexion seen. Abduction improved during the trial. The incidence of skin problems was equivalent to that experienced with the traditional boots and bar that the children had been wearing. Conclusion: Good compliance and parental satisfaction, coupled with no deterioration in foot morphology, abduction or dorsiflexion present the abduction dorsiflexion mechanism boot as a feasible alternative to the traditional boots and bar, particularly in children with unilateral congenital talipes equinovarus. Clinical relevance: The abduction dorsiflexion mechanism is currently the subject of considerable interest as clinicians look to increase compliance and reduce the recurrence rate in Ponseti-treated congenital talipes equinovarus. The abduction dorsiflexion mechanism boot is a feasible alternative to the traditional boots and bar, particularly in children with unilateral congenital talipes equinovarus.

Peyronie’s disease, congenital curvature, and chordee

Penile curvature is usually secondary to Peyronie’s disease, which is a fibrotic wound healing disorder of the tunica albuginea. Other causes include congenital penile curvature and chordee. Penile deformity, if severe, results in significant difficulties with sexual intercourse and may make sexual intercourse impossible. The mainstay of treatment, if the deformity is stable and interfering with intercourse is surgery, while a variety of surgical treatments exist. Side effects of treatment include penile shortening, erectile dysfunction, and recurrent deformity. Medical treatments are usually ineffective, although recently, injections of intralesional collagenase have been licensed in the United States for Peyronie’s disease.

Correction of Hammertoe Deformity With Novel Intramedullary PIP Fusion Device Versus K-Wire Fixation

Background: K-wire fixation has been the most common method of fixation for hammertoe deformity. However intramedullary devices are gaining ground in both number of available choices and in procedures performed. This study aimed to compare the outcomes of hammertoe correction performed with K-wire fixation versus a novel intramedullary fusion device (CannuLink). Methods: A retrospective review of hammertoe correction by a single surgeon was performed from June 2011 to December 2013. Sixty patients (95 toes) underwent K-wire fixation and 39 patients (54 toes) underwent fusion with the CannuLink implant. Average age was 61.7 years and 61.4 years, respectively. Average length of follow-up was 12.9 and 12.3 months, respectively. Patients were evaluated for medical comorbidities, smoking status, inflammatory arthritis, peripheral vascular disease, peripheral neuropathy, pre- and postoperative visual analog pain scale, bony union percentage, revision rate, complications (hardware and surgery-related), and persistent symptoms at last follow-up. There was no significant difference in demographics or comorbidities between the 2 groups ( P > .05). Results: In the K-wire group, 16 patients (18 toes) remained symptomatic at last follow-up (27%). Nine toes (9.5%) had recurrent deformity, 3 toes (3%) developed a late infection because of the recurrent deformity, and 1 toe (1%) developed partial numbness. One patient suffered a calf deep vein thrombosis (DVT) and peroneal nerve neuritis, 1 patient developed foot drop, and 3 patients continued to complain of pain. Five toes required revision surgery (5.3%). In the intramedullary group, 3 (7.7%) patients remained symptomatic and all were associated with a complication. One patient developed chronic regional pain syndrome in the foot, a calf DVT, and a nonfatal pulmonary embolus. A second patient developed a painless recurrent deformity. A third patient had wound dehiscence. Nobody had hardware failure or required a second operation. Conclusion: The CannuLink intramedullary device for hammertoe correction resulted in fewer complications, only 1 recurrent deformity, and no reoperations compared with K-wire fixation. Level of Evidence: Level III, retrospective comparative study.

Congenital talipes equinovarus

♦ Aetiology of idiopathic congenital talipes equinovarus remains unknown♦ Antenatal diagnosis is common with good differentiation of the idiopathic from the syndromic foot♦ The Ponseti method is the treatment of choice: results are poorer in the atypical and syndromic feet♦ Surgery is required in selected cases as the primary treatment and in others, as treatment for residual and/or recurrent deformity.

THE PROGNOSIS OF FASCIECTOMY FOR ABDUCTOR DIGITI MINIMI AND PRETENDINOUS CORDS IN DUPUYTREN'S DISEASE OF THE LITTLE FINGER

Thirty-nine consecutive patients with little finger Dupuytren's contracture underwent open fasciectomy. Diseased abductor digiti minimi (ADM) pretendinous (PT) cords were identified. The mean pre-operative PIPJ contracture was 77° in the PT group and 66° in the ADM group. Mean residual deformity was 12° in the PT group and 9° in the ADM group. At six months, ten out of 27 patients had developed a recurrent deformity in the PT group (mean 24°) and seven out of 11 in the ADM group (mean 18°). There was no statistically significant difference between the two groups at any stage. Dupuytren's contracture of the little finger is as a result of an ADM cord in 29% of cases. In this series it led to an isolated contracture of the PIPJ in the majority of cases and rarely affected the MCPJ. Disease of the ADM cord was not associated with a difference in contracture or prognosis compared to a PT cord.