CORRECTION OF TRAUMATIC TALIPES EQUINOVARUS WITH Ilizarov AND NON-FUSION TECHNIQUES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LILang ^1,2 , HUANGQi ¹ , GAOFeng ¹ ,  ZHANGHui ²

1. Department of Orthopedics, Branch Hospital of Tibetan Office in Chengdu, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;
2. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

ZHANGHui, Email: caesarzh@163.com

Keywords：

Ilizarov technique; External fixator; Talipes equinovarus; Orthopedics

DOI：

10.7507/1002-1892.20140183

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Objective To investigate the effectiveness of the Ilizarov technique for the treatment of traumatic talipes equinovarus so as to provide the evidence for the clinical practice. Methods Between February 2011 and April 2012,42 patients with traumatic talipes equinovarus received treatment by Ilizarov technique,including 29 males and 13 females aged 17-55 years (mean,34.3 years).The left side was involved in 24 cases,and the right side in 18 cases.The disease duration was 6 months to 6 years (mean,2.7 years).According to the principles of Ilizarov,a ring external fixator was applied on the affected foot and lower leg.The threaded rods and screw nuts were revolved according to the tolerance of patients at 3-7 days after fixation.At first,forefoot varus or foot inversion was corrected,and then drooping feet deformity was corrected.The patients were encouraged to begin weight-bearing walking after correction.X-ray films were taken regularly to observe the ankle joint and avoid its dislocation.The external fixator was maintained in neutral position for 8-12 weeks after achieving satisfactory correction.An walking ankle-foot orthosis and a sleeping ankle-foot orthosis were used for more than 16 weeks after removal of the fixator.The outcome was assessed with American Orthopaedic Foot and Ankle Society (AOFAS) comprehensive scoring system and visual analogue scale (VAS) pain score. Results Forty-two patients were followed up 14.3 months on average (range,10-24 months).All the patients achieved 0° dorsiflexion at 4-13 weeks (mean,6.8 weeks) after treatment with Ilizarov apparatus.The fixator was maintained for 10.7 weeks on average (range,10-16 weeks) after correction.No dislocation of the ankle joint and no damage to nerves and blood vessels occurred.The deformity of plantar flexion (10°) was found in 3 patients.At last follow-up,the patients could walk normally.AOFAS score was significantly increased to 93.4±8.0 from 52.7±10.1 at preoperation (t=-7.035,P=0.008);according to AOFAS scoring system,24 cases were grades as excellent,14 as good,2 as moderate,and 2 as poor,and the excellent and good rate was 90.5%.The VAS score of the foot significantly decreased to 3.51±1.44 from 7.55±1.39 at preoperation (t=-0.564,P=0.025). Conclusion Ilizarov technique combined with non-fusion has satisfactory effectiveness in correction of traumatic talipes equinovarus.It is a safe,effective,and minimally invasive method.

Citation： LILang, HUANGQi, GAOFeng, ZHANGHui. CORRECTION OF TRAUMATIC TALIPES EQUINOVARUS WITH Ilizarov AND NON-FUSION TECHNIQUES. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(7): 823-827. doi: 10.7507/1002-1892.20140183 Copy

1.	Camathias C,Valderrabano V,Oberli H.Routine pin tract care in external fixation is unnecessary:a randomised,prospective,blinded controlled study.Injury,2012,43(11):1969-1973.
2.	秦泗河,郭保逢,任龙喜,等.有限矫形手术与Ilizarov 技术治疗青少年先天性马蹄内翻足.中国修复重建外科杂志,2012,26(1):31-35.
3.	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.
4.	Frost HM.A 2003 update of bone physiology and wolff's law for clinicians.Angle Orthod,2004,74(1):3-15.
5.	Lawrence SJ.Open caleaneal fractures:assessment and management.Foot Ankle Clin,2005,10(3):491-502,vi.
6.	Makhdoom A,Qureshi PA,Jokhio MF,et al.Resistant clubfoot deformities managed by Ilizarov distraction histogenesis.Indian J Orthop,2012,46(3):326-332.
7.	Ullmann Y,Fodor L,Soudry M,et al.The llizarov technique in joint contractures and dislocations.Acta Orthop Belg,2007,73(1):77-82.
8.	陈建文,秦泗河,郑学建,等.Ilizarov技术矫治马蹄足畸形的临床应用进展.中国矫形外科杂志,2010,18(1):53-57.
9.	Ilizarov GA.The tension-stress effect on the genesis and growth of tissues.Part Ⅱ.The influence of the rate and frequence of distraction.Clin Orthop Relat Res,1989,(239):263-285.
10.	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.
11.	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.中国创伤骨科杂志,2007,9(12):1106-1110.
12.	Ahmed AA.The use of the Ilizarov method in management of relapsed club foot.Orthopedics,2010,33(12):881.
13.	王正义,张建中,俞光荣.足踝外科学.北京:人民卫生出版社,2006:620-621.
14.	Gupta P,Bither N.Ilizarov in relapsed clubfoot:a necessary evil? J Pediatr Orthop B,2013,22(6):589-594.
15.	黄雷,张建立,王慎东,等.Ilizarov外固定架治疗创伤性马蹄足.中华创伤骨科杂志,2006,8(5):411-414.
16.	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.
17.	Bradish CF,Noor S.The Ilizarov method in the management of relapsed club feet.J Bone Joint Surg (Br),2000,82(3):387-391.
18.	Refai MA,Song SH,Song HR.Does short-term application of an Ilizarov frame with transfixion pins correct relapsed clubfoot in children? Clin Orthop Relat Res,2012,470(7):1992-1999.
19.	Tripathy SK,Saini R,Sudes P,et al.Application of the Ponseti principle for deformity correction in neglected and relapsed clubfoot using the Ilizarov fixator.J Pediatr Orthop B,2011,20(1):26-32.
20.	Lee DY,Choi IH,Yoo WJ,et al.Application of the Ilizarov technique to the correction of neurologic equinocavovams foot deformity.Clin Orthop Relat Res,2011,469(3):860-867.
21.	常峰,陈斌,荆志振,等.Ilizarov技术矫治复杂僵硬性马蹄内翻足.中华骨科杂志,2012,32(3):222-228.

1. Camathias C,Valderrabano V,Oberli H.Routine pin tract care in external fixation is unnecessary:a randomised,prospective,blinded controlled study.Injury,2012,43(11):1969-1973.
2. 秦泗河,郭保逢,任龙喜,等.有限矫形手术与Ilizarov 技术治疗青少年先天性马蹄内翻足.中国修复重建外科杂志,2012,26(1):31-35.
3. 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.
4. Frost HM.A 2003 update of bone physiology and wolff's law for clinicians.Angle Orthod,2004,74(1):3-15.
5. Lawrence SJ.Open caleaneal fractures:assessment and management.Foot Ankle Clin,2005,10(3):491-502,vi.
6. Makhdoom A,Qureshi PA,Jokhio MF,et al.Resistant clubfoot deformities managed by Ilizarov distraction histogenesis.Indian J Orthop,2012,46(3):326-332.
7. Ullmann Y,Fodor L,Soudry M,et al.The llizarov technique in joint contractures and dislocations.Acta Orthop Belg,2007,73(1):77-82.
8. 陈建文,秦泗河,郑学建,等.Ilizarov技术矫治马蹄足畸形的临床应用进展.中国矫形外科杂志,2010,18(1):53-57.
9. Ilizarov GA.The tension-stress effect on the genesis and growth of tissues.Part Ⅱ.The influence of the rate and frequence of distraction.Clin Orthop Relat Res,1989,(239):263-285.
10. 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.
11. 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.中国创伤骨科杂志,2007,9(12):1106-1110.
12. Ahmed AA.The use of the Ilizarov method in management of relapsed club foot.Orthopedics,2010,33(12):881.
13. 王正义,张建中,俞光荣.足踝外科学.北京:人民卫生出版社,2006:620-621.
14. Gupta P,Bither N.Ilizarov in relapsed clubfoot:a necessary evil? J Pediatr Orthop B,2013,22(6):589-594.
15. 黄雷,张建立,王慎东,等.Ilizarov外固定架治疗创伤性马蹄足.中华创伤骨科杂志,2006,8(5):411-414.
16. 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.
17. Bradish CF,Noor S.The Ilizarov method in the management of relapsed club feet.J Bone Joint Surg (Br),2000,82(3):387-391.
18. Refai MA,Song SH,Song HR.Does short-term application of an Ilizarov frame with transfixion pins correct relapsed clubfoot in children? Clin Orthop Relat Res,2012,470(7):1992-1999.
19. Tripathy SK,Saini R,Sudes P,et al.Application of the Ponseti principle for deformity correction in neglected and relapsed clubfoot using the Ilizarov fixator.J Pediatr Orthop B,2011,20(1):26-32.
20. Lee DY,Choi IH,Yoo WJ,et al.Application of the Ilizarov technique to the correction of neurologic equinocavovams foot deformity.Clin Orthop Relat Res,2011,469(3):860-867.
21. 常峰,陈斌,荆志振,等.Ilizarov技术矫治复杂僵硬性马蹄内翻足.中华骨科杂志,2012,32(3):222-228.

Chinese Journal of Reparative and Reconstructive Surgery

CORRECTION OF TRAUMATIC TALIPES EQUINOVARUS WITH Ilizarov AND NON-FUSION TECHNIQUES

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