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.	陈建文, 秦泗河. 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.
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.	刘昆, 梅海波, 赫荣国, 等. 应用 Ilizarov 技术治疗儿童复发性僵硬型先天性马蹄内翻足. 临床小儿外科杂志, 2016, 15(6): 535-539.
14.	秦泗河. Ilizarov 技术概述. 中华骨科杂志, 2006, 26(9): 642-645.
15.	高纯志, 吴晗, 肖鹏, 等. Ilizarov 技术结合有限手术治疗青少年痉挛性马蹄内翻足畸形. 中国修复重建外科杂志, 2018, 32(2): 182-186.
16.	郑学建, 秦泗河, 郭保逢, 等. Ilizarov 踝关节弹性斜拉牵伸器在矫治重度马蹄足畸形中的应用. 中华创伤骨科杂志, 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, 孙克明, 王军建, 等. Ilizarov 外固定架联合有限矫形手术治疗青少年Ⅲ度马蹄内翻足畸形的临床疗效. 中国临床医学, 2017, 24(5): 719-722.
19.	董震, 王林涛, 齐鹏, 等. Ilizarov 外固定架联合跟骨截骨矫正痉挛性马蹄内翻足. 中国现代医学杂志, 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. 陈建文, 秦泗河. 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.
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. 刘昆, 梅海波, 赫荣国, 等. 应用 Ilizarov 技术治疗儿童复发性僵硬型先天性马蹄内翻足. 临床小儿外科杂志, 2016, 15(6): 535-539.
14. 秦泗河. Ilizarov 技术概述. 中华骨科杂志, 2006, 26(9): 642-645.
15. 高纯志, 吴晗, 肖鹏, 等. Ilizarov 技术结合有限手术治疗青少年痉挛性马蹄内翻足畸形. 中国修复重建外科杂志, 2018, 32(2): 182-186.
16. 郑学建, 秦泗河, 郭保逢, 等. Ilizarov 踝关节弹性斜拉牵伸器在矫治重度马蹄足畸形中的应用. 中华创伤骨科杂志, 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, 孙克明, 王军建, 等. Ilizarov 外固定架联合有限矫形手术治疗青少年Ⅲ度马蹄内翻足畸形的临床疗效. 中国临床医学, 2017, 24(5): 719-722.
19. 董震, 王林涛, 齐鹏, 等. Ilizarov 外固定架联合跟骨截骨矫正痉挛性马蹄内翻足. 中国现代医学杂志, 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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