Treatment of rigid congenital clubfoot with Ilizarov technique in older children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Hang ,  LI Ming , LIU Xing , LUO Cong , CAO Yujiang , LIU Chuankang , QU Xiangyang

Orthopedic Center of Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, P.R.China;

Corresponding?author：

LI Ming, Email: LM3180@163.com

Keywords：

Child; rigid congenital clubfoot; Ilizarov technique; soft tissue release

DOI：

10.7507/1002-1892.201805005

Video：

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Objective To investigate the effectiveness of Ilizarov technique in treatment of rigid congenital clubfoot in older children. Methods A clinical data of 55 patients (69 feet) with rigid congenital clubfoot (Diméglio grade Ⅳ) between September 2005 and September 2015 were retrospectively analyzed. There were 33 boys and 22 girls with an average age of 11 years (range, 6-14 years). There were 41 cases of unilateral clubfoot and 14 cases of bilateral clubfeet. The degree of foot deformity was rated as fair in 24 feet and as poor in 45 feet according to International Clubfoot Study Group (ICFSG) score before operation. Sixty-nine feet were treated by Ilizarov external fixator combined with limited soft tissue release, and 21 feet were combined with individualized V-shaped osteotomies. Results All patients were followed up 2-10 years ( mean, 4.2 years). The incisions healed well after operation. Five cases of needle tract infection occurred and were cured by local dressing change. The effectiveness was excellent in 39 feet, good in 21 feet, and fair in 9 feet according to ICFSG score, with the excellent and good rate of 87.0%. During the follow-up, X-ray films showed that no blood supply disorder or necrosis of talus, scaphoid, cuneiform, metatarsal, calcaneus, and cuboid occurred. No osteomyelitis occurred. Conclusion Ilizarov technique combined with limited soft tissue release or V-shaped osteotomy for the older children with rigid congenital clubfeet is safe and can obtain significant orthopedic effectiveness.

Citation： LIU Hang, LI Ming, LIU Xing, LUO Cong, CAO Yujiang, LIU Chuankang, QU Xiangyang. Treatment of rigid congenital clubfoot with Ilizarov technique in older children. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(10): 1267-1270. doi: 10.7507/1002-1892.201805005 Copy

1.	Fernandes RM, Mendes MD, Amorim R, et al. Surgical treatment of neglected clubfoot using external fixator. Rev Bras Ortop, 2016, 51(5): 501-508.
2.	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.
3.	陳建文, 秦泗河. Ilizarov 技術矯治馬蹄足畸形的臨床應用進展. 中國矯形外科雜志, 2010, 18(1): 53-57.
4.	Bensahela H, Kuo K, Duhaime M, et al. Outcome evaluation of the treatment of clubfoot: the international language of clubfoot. J Pediatr Orthop B, 2003, 12(4): 269-271.
5.	Chu A, Lehman WB. Treatment of idiopathic clubfoot in the ponseti era and beyond. Foot Ankle Clin, 2015, 20(4): 555-562.
6.	Ganger R, Radler C, Handlbauer A, et al. External fixation in clubfoot treatment-a review of the literature. J Pediatr Orthop B, 2012, 21(1): 52-58.
7.	Alkar F, Louahem D, Bonnet F, et al. Long-term results after extensive soft tissue release in very severe congenital clubfeet. J Pediatr Orthop, 2017, 37(7): 500-503.
8.	Radler C, Mindler GT. Treatment of severe recurrent clubfoot. Foot Ankle Clin, 2015, 20(4): 563-586.
9.	El-Sherbini MH, Omran AA. Midterm follow-up of talectomy for severe rigid equinovarus feet. J Foot Ankle Surg, 2015, 54(6): 1093-1098.
10.	El-Mowafi H, El-Alfy B, Refai M. Functional outcome of salvage of residual and recurrent deformities of clubfoot with Ilizarov technique. Foot Ankle Surg, 2009, 15(1): 3-6.
11.	El Barbary H, Abdel Ghani H, Hegazy M. Correction of relapsed or neglected clubfoot using a simple Ilizarov frame. Int Orthop, 2004, 28(3): 183-186.
12.	Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. PartⅠ. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res, 1989, (238): 249-281.
13.	劉昆, 梅海波, 赫榮國, 等. 應用 Ilizarov 技術治療兒童復發性僵硬型先天性馬蹄內翻足. 臨床小兒外科雜志, 2016, 15(6): 535-539.
14.	秦泗河. Ilizarov 技術概述. 中華骨科雜志, 2006, 26(9): 642-645.
15.	高純志, 吳晗, 肖鵬, 等. Ilizarov 技術結合有限手術治療青少年痙攣性馬蹄內翻足畸形. 中國修復重建外科雜志, 2018, 32(2): 182-186.
16.	鄭學建, 秦泗河, 郭保逢, 等. Ilizarov 踝關節彈性斜拉牽伸器在矯治重度馬蹄足畸形中的應用. 中華創傷骨科雜志, 2015, (12): 1035-1041.
17.	Ferreira RC, Costo MT, Frizzo GG, et al. Correction of neglected clubfoot using the Ilizarov external fixator. Foot Ankle Int, 2006, 27(4): 266-273.
18.	郭占豪, 孫克明, 王軍建, 等. Ilizarov 外固定架聯合有限矯形手術治療青少年Ⅲ度馬蹄內翻足畸形的臨床療效. 中國臨床醫學, 2017, 24(5): 719-722.
19.	董震, 王林濤, 齊鵬, 等. Ilizarov 外固定架聯合跟骨截骨矯正痙攣性馬蹄內翻足. 中國現代醫學雜志, 2017, 27(10): 80-84.
20.	Shalaby H, Hefny H. Correction of complex foot deformities using the V-osteotomy and the Ilizarov technique. Strategies Trauma Limb Reconstr, 2007, 2(1): 21-30.
21.	Gupta P, Bither N. Ilizarov in relapsed clubfoot: a necessary evil? J Pediatr Orthop B, 2013, 22(6): 589-594.
22.	Faldini C, Traina F, Nanni M, et al. Congenital idiopathic talipes equinovarus before and after walking age: observations and strategy of treatment from a series of 88 cases. J Orthop Traumatol, 2016, 17(1): 81-87.

1. Fernandes RM, Mendes MD, Amorim R, et al. Surgical treatment of neglected clubfoot using external fixator. Rev Bras Ortop, 2016, 51(5): 501-508.
2. 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.
3. 陳建文, 秦泗河. Ilizarov 技術矯治馬蹄足畸形的臨床應用進展. 中國矯形外科雜志, 2010, 18(1): 53-57.
4. Bensahela H, Kuo K, Duhaime M, et al. Outcome evaluation of the treatment of clubfoot: the international language of clubfoot. J Pediatr Orthop B, 2003, 12(4): 269-271.
5. Chu A, Lehman WB. Treatment of idiopathic clubfoot in the ponseti era and beyond. Foot Ankle Clin, 2015, 20(4): 555-562.
6. Ganger R, Radler C, Handlbauer A, et al. External fixation in clubfoot treatment-a review of the literature. J Pediatr Orthop B, 2012, 21(1): 52-58.
7. Alkar F, Louahem D, Bonnet F, et al. Long-term results after extensive soft tissue release in very severe congenital clubfeet. J Pediatr Orthop, 2017, 37(7): 500-503.
8. Radler C, Mindler GT. Treatment of severe recurrent clubfoot. Foot Ankle Clin, 2015, 20(4): 563-586.
9. El-Sherbini MH, Omran AA. Midterm follow-up of talectomy for severe rigid equinovarus feet. J Foot Ankle Surg, 2015, 54(6): 1093-1098.
10. El-Mowafi H, El-Alfy B, Refai M. Functional outcome of salvage of residual and recurrent deformities of clubfoot with Ilizarov technique. Foot Ankle Surg, 2009, 15(1): 3-6.
11. El Barbary H, Abdel Ghani H, Hegazy M. Correction of relapsed or neglected clubfoot using a simple Ilizarov frame. Int Orthop, 2004, 28(3): 183-186.
12. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. PartⅠ. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res, 1989, (238): 249-281.
13. 劉昆, 梅海波, 赫榮國, 等. 應用 Ilizarov 技術治療兒童復發性僵硬型先天性馬蹄內翻足. 臨床小兒外科雜志, 2016, 15(6): 535-539.
14. 秦泗河. Ilizarov 技術概述. 中華骨科雜志, 2006, 26(9): 642-645.
15. 高純志, 吳晗, 肖鵬, 等. Ilizarov 技術結合有限手術治療青少年痙攣性馬蹄內翻足畸形. 中國修復重建外科雜志, 2018, 32(2): 182-186.
16. 鄭學建, 秦泗河, 郭保逢, 等. Ilizarov 踝關節彈性斜拉牽伸器在矯治重度馬蹄足畸形中的應用. 中華創傷骨科雜志, 2015, (12): 1035-1041.
17. Ferreira RC, Costo MT, Frizzo GG, et al. Correction of neglected clubfoot using the Ilizarov external fixator. Foot Ankle Int, 2006, 27(4): 266-273.
18. 郭占豪, 孫克明, 王軍建, 等. Ilizarov 外固定架聯合有限矯形手術治療青少年Ⅲ度馬蹄內翻足畸形的臨床療效. 中國臨床醫學, 2017, 24(5): 719-722.
19. 董震, 王林濤, 齊鵬, 等. Ilizarov 外固定架聯合跟骨截骨矯正痙攣性馬蹄內翻足. 中國現代醫學雜志, 2017, 27(10): 80-84.
20. Shalaby H, Hefny H. Correction of complex foot deformities using the V-osteotomy and the Ilizarov technique. Strategies Trauma Limb Reconstr, 2007, 2(1): 21-30.
21. Gupta P, Bither N. Ilizarov in relapsed clubfoot: a necessary evil? J Pediatr Orthop B, 2013, 22(6): 589-594.
22. Faldini C, Traina F, Nanni M, et al. Congenital idiopathic talipes equinovarus before and after walking age: observations and strategy of treatment from a series of 88 cases. J Orthop Traumatol, 2016, 17(1): 81-87.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of rigid congenital clubfoot with Ilizarov technique in older children

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