Research Article
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Pes ekinovarus hastalarına uygulanan cerrahi tedavilerin erken klinik ve radyolojik sonuçları

Year 2019, Volume: 16 Issue: 1, 77 - 81, 22.03.2019

Abstract

Amaç:
Dirençli ve ihmal edilmiş idyopatik pes ekinovarus hastalarında uygulanan
yumuşak doku cerrahilerindeki erken dönem klinik ve radyolojik sonuçlarını
değerlendirmek.

Metod:
Bu çalışmada, Haziran 2014 -Ağustos 2018 tarihleri arasında doğuştan çarpık
ayak nedeniyle başvuran ve yaş aralığı 9-87 ay (33 erkek, 10 kız; ort:
operasyon yaşı: 31,5 ay) olan 43 hastanın 56 ayağında uygulanan yumuşak doku
cerrahileri, geri dönük olarak incelendi. Takip süresi 12-36 aydı. (ort; 20,2
ay). Hastaların fizik muayene bulguları ve radyolojik incelemelerine göre operasyon
öncesi Pirani skorları ve radyolojik ölçümleri operasyon sonrası 3. aydan
sonraki son ziyaretleriyle karşılaştırıldı.

Bulgular:
Operasyon öncesi Pirani skorlarında görünüş, son kontrolde yapılan ölçümlerle
karşılaştırıldığında 4’den
fazla azalma olan hastalar çok iyi (11 ayak, %19,6), 3-4 arası azalma
iyi-tatminkar (27 ayak, %48,2), 3’ün
altında azalma kötü (18 ayak, %32,2) olarak bulundu. Operasyon öncesine göre
klinik değerlendirmede (Pirani skoru) anlamlı düzelme tespit edildi (p˂0,001).
Radyolojik incelemelerde operasyon öncesine göre anlamlı düzelme tespit edildi
(p˂0,001). 16 hastada (%28,5) çeşitli derecelerde yara yeri açılması ve cilt
nekrozu gelişti. 7 metatarsus adduktus, 3 hastada ekin varus deformitesi ve 2
hastada ön ayak supinasyonu, 1 tel çıkması gözlendi.







Sonuç:
Dirençli ve ihmal edilmiş
İPEV
olgularda yumuşak doku cerrahileri erken dönemde, klinik ve radyolojik olarak tatminkâr
bulunmuştur.

References

  • 1. Turco VJ. Surgical correction of the resistant club foot. One stage posteromedial release with internal fixation. A preliminary report. J Bone Joint Surg Am. 1971;53A: 477-97.
  • 2. Nordin S, Aidura M, Razak S, Faisham W. Controversies in congenital clubfoot : literature review. Malays J Med Sci. 2002;9:34–40.
  • 3. Saltzman CL, Fehrle MJ, Cooper RR, Spencer EC, Ponseti IV. Triple arthrodesis: twenty-five and forty-four-year average follow-up of the same patients. J Bone Joint Surg Am. 1999;81:1391–402.
  • 4. Dietz FR. Treatment of a recurrent clubfoot deformity after initial correction with the Ponseti technique. AAOS Instr Course Lect 2006;55:625-9.
  • 5. Lourenço AF, Morcuende JA. Correction of neglected idiopathic club foot by the Ponseti method. J Bone Joint Surg [Br]. 2007;89-B:378-81.
  • 6. Huang YT, Lei W, Zhao L, Wang J. The treatment of congenital club foot by operation to correct deformity and achieve dynamic muscle balance. J Bone Joint Surg [Br]. 1999;81-B:858-62.
  • 7. El Barbary H, Abdel Ghani H, Hegazy M. Correction of relapsed or neglected clubfoot using a simple Ilizarov frame. Int Orthop. 2004;28:183-6.
  • 8. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg [Am] 1980;62-A:23-31.
  • 9. Main BJ, Crider RJ, Polk M, et al. The results of early operation in talipes equinovarus: a preliminary report. J Bone Joint Surg [Br]. 1977;59-B:337-41.
  • 10. Bensahel H, Csukonyi Z, Desgrippes Y, Chaumien JP. Surgery in residual clubfoot: one-stage medioposterior release “à La Carte”. J Pediatr Orthop. 1987;7:145-8.
  • 11. Ramachandran M, Eastwood DM. Botulinum toxin and its orthopaedic applications. J Bone Joint Surg [Br]. 2006;88-B:981-7.
  • 12. Siapkara A, Duncan R. Congenital talipes equinovarus: a review of current management. J Bone Joint Surg [Br]. 2007;89-B:995-1000.
  • 13. Dunkley M, Gelfer Y, Jackson D, Parnell E, Armstong J, Rafter. Mid-term results of a physiotherapist-led Ponseti service for the management of non-idiopathic and idiopathic clubfoot. J Child Orthop. 2015; 9(3):183–9.
  • 14. McKay SD, Dolan LA, Morcuende JA. Treatment results of late-relapsing idiopathic clubfoot previously treated with the Ponseti method. J Pediatr Orthop. 2012; 32(4):406–11.
  • 15. Richards BS, Faulks S, Rathjen KE, Karol LA, Johnston CE, Jones SA. A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional (physiotherapy) method. J Bone Joint Surg Am. 2008;90(11):2313–21.
  • 16. Turco VJ. Resistant congenital club foot: one-stage posteromedial release with internal fixation. J Bone Joint Surg [Am] 1979;61-A:805-14.
  • 17. Bocahut N, Simon AL, Mazda K, Ilharreborde B, Souchet P. Medial to posterior release procedure after failure of functional treatment in clubfoot: a prospective study. J Child Orthop. 2016;10:109–17.
  • 18. Main BJ, Crider RJ, Polk M, Lloyd-Roberts GC, Swann M, Kamdar BA. The results of early operation in talipes equinovarus. A preliminary report. J Bone Joint Surg Br 1977; 5983; 337-41.
  • 19. Pirani S, Outerbridge H, Moran M, Sawatsky B. A method of evaluating virgin clubfoot with substantial interobserver reliability. POSNA (Abstract) 1995.
  • 20. Cohen-Sobel E, Caesli M, Giorgini R. Long term follow up of clubfoot surgery; analysis of 44 patients. J Foot Ankle Surg. 1993;32:411–23.
  • 21. Roye BD, Vitale MG, Gelijns AC, Roye DP Jr. Patient based outcomes after clubfoot surgery. J Paediatr Orthop. 2001;21(1):42–9.
  • 22. Uglow MG, Clarke NMP. The functional outcome of staged surgery for the correction of talipes equinovarus. J Paediatr Orthop. 2000;20(4):517–23.
  • 23. Prasad P, Sen RK, Gill SS, Wardak E, Saini R. Clinico-radiological assessment and their correlation in clubfeet treated with postero-medial soft-tissue release. International Orthopaedics (SICOT). 2009;33:225–9.
  • 24. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. J Bone Joint Surg (Am). 1995;77:1477–89.
  • 25. Hutchins PM, Foster BK, Paterson DC, Cole EA. Long term results of early surgical release in clubfeet. J Bone Joint Surg (Br). 1985; 67:791–9.
  • 26. Thompson GH, Richardson AB, Westin GW. Surgical Management of resistant congenital talipes equinovarus. J Bone Joint Surg (Am). 1982;64:652–65.
  • 27. Lau JH, Meyer LC, Lau HC. Results of surgical treatment of talipes equinovarus congenita. Clin Orthop. 1989;248:219–26.
  • 28. Haasbeek JF, Weight JG. A comparison of long term results of posterior and comprehensive release in the treatment of clubfoot. J Paediatr Orthop. 1997;17(1):29-35.
  • 29. Ponseti LV, EL-Khoury GY, Ippolito E, Weinstein SL. A radiographic study of skeletal deformities in treated clubfeet. Clin Orthop. 1981;160:30–42.
  • 30. Green ADL, L1oyd-Roberts GC. Results of Early Posterior Release in Resistant Club Feet. J Bone and Joint Surg. 1985;67(B):583-93.
  • 31. Nimityongskul P, Anderson LO, Herbert DE. Surgical Treatment of Club Foot: A Comparisian of 2 Techniques. Foot & Ankle. 1992;13(3):116-124.

Early clinical and radiological results of surgical treatments for pes equinovarus patients

Year 2019, Volume: 16 Issue: 1, 77 - 81, 22.03.2019

Abstract

Background:
To evaluate the early clinical and radiological results of soft tissue
surgeries in patients with resistant and neglected idiopathic pes equinovarus.

Methods: In this study,
between June 2014 and August 2018, who presented with congenital club foot aged
between 9-87 months (33 males, 10 females; mean age: 31.5 months) were
performed soft tissue surgeries in 56 feet of 43 patients viewed
retrospectively. Follow-up was 12-36 months. (mean; 20,2 months). According to
the physical examination findings and radiological examinations of the
patients, Pirani scores and radiological measurements were compared with the
last visits after the 3rd month after the operation.

Results: Compared to
preoperative measurements with Pirani scores after 3 months, patients with more
than 4 decreases were very good (11 feet, 19,6%), and the reduction of 3-4 was
good (27 feet, 48,2%). Less than 3 decrease was poor (18 foot, 32,2%). Significant
improvement was detected in the clinical evaluation (Pirani score) (p
˂0,001). Significant improvement was detected
in radiological examinations (p
˂0,001).
16 patients (28,5%) developed various types of wound healing problems and skin
necrosis. 7 metatarsus adductus, 3 patients with equinus varus deformity and 2
patients with forefoot supination and 1 wire out were observed.

Conclusion:  The soft tissue surgeries performed in the
resistant and neglected IPEV patients were found satisfactory in terms of early
clinical and radiological results.









 

References

  • 1. Turco VJ. Surgical correction of the resistant club foot. One stage posteromedial release with internal fixation. A preliminary report. J Bone Joint Surg Am. 1971;53A: 477-97.
  • 2. Nordin S, Aidura M, Razak S, Faisham W. Controversies in congenital clubfoot : literature review. Malays J Med Sci. 2002;9:34–40.
  • 3. Saltzman CL, Fehrle MJ, Cooper RR, Spencer EC, Ponseti IV. Triple arthrodesis: twenty-five and forty-four-year average follow-up of the same patients. J Bone Joint Surg Am. 1999;81:1391–402.
  • 4. Dietz FR. Treatment of a recurrent clubfoot deformity after initial correction with the Ponseti technique. AAOS Instr Course Lect 2006;55:625-9.
  • 5. Lourenço AF, Morcuende JA. Correction of neglected idiopathic club foot by the Ponseti method. J Bone Joint Surg [Br]. 2007;89-B:378-81.
  • 6. Huang YT, Lei W, Zhao L, Wang J. The treatment of congenital club foot by operation to correct deformity and achieve dynamic muscle balance. J Bone Joint Surg [Br]. 1999;81-B:858-62.
  • 7. El Barbary H, Abdel Ghani H, Hegazy M. Correction of relapsed or neglected clubfoot using a simple Ilizarov frame. Int Orthop. 2004;28:183-6.
  • 8. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg [Am] 1980;62-A:23-31.
  • 9. Main BJ, Crider RJ, Polk M, et al. The results of early operation in talipes equinovarus: a preliminary report. J Bone Joint Surg [Br]. 1977;59-B:337-41.
  • 10. Bensahel H, Csukonyi Z, Desgrippes Y, Chaumien JP. Surgery in residual clubfoot: one-stage medioposterior release “à La Carte”. J Pediatr Orthop. 1987;7:145-8.
  • 11. Ramachandran M, Eastwood DM. Botulinum toxin and its orthopaedic applications. J Bone Joint Surg [Br]. 2006;88-B:981-7.
  • 12. Siapkara A, Duncan R. Congenital talipes equinovarus: a review of current management. J Bone Joint Surg [Br]. 2007;89-B:995-1000.
  • 13. Dunkley M, Gelfer Y, Jackson D, Parnell E, Armstong J, Rafter. Mid-term results of a physiotherapist-led Ponseti service for the management of non-idiopathic and idiopathic clubfoot. J Child Orthop. 2015; 9(3):183–9.
  • 14. McKay SD, Dolan LA, Morcuende JA. Treatment results of late-relapsing idiopathic clubfoot previously treated with the Ponseti method. J Pediatr Orthop. 2012; 32(4):406–11.
  • 15. Richards BS, Faulks S, Rathjen KE, Karol LA, Johnston CE, Jones SA. A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional (physiotherapy) method. J Bone Joint Surg Am. 2008;90(11):2313–21.
  • 16. Turco VJ. Resistant congenital club foot: one-stage posteromedial release with internal fixation. J Bone Joint Surg [Am] 1979;61-A:805-14.
  • 17. Bocahut N, Simon AL, Mazda K, Ilharreborde B, Souchet P. Medial to posterior release procedure after failure of functional treatment in clubfoot: a prospective study. J Child Orthop. 2016;10:109–17.
  • 18. Main BJ, Crider RJ, Polk M, Lloyd-Roberts GC, Swann M, Kamdar BA. The results of early operation in talipes equinovarus. A preliminary report. J Bone Joint Surg Br 1977; 5983; 337-41.
  • 19. Pirani S, Outerbridge H, Moran M, Sawatsky B. A method of evaluating virgin clubfoot with substantial interobserver reliability. POSNA (Abstract) 1995.
  • 20. Cohen-Sobel E, Caesli M, Giorgini R. Long term follow up of clubfoot surgery; analysis of 44 patients. J Foot Ankle Surg. 1993;32:411–23.
  • 21. Roye BD, Vitale MG, Gelijns AC, Roye DP Jr. Patient based outcomes after clubfoot surgery. J Paediatr Orthop. 2001;21(1):42–9.
  • 22. Uglow MG, Clarke NMP. The functional outcome of staged surgery for the correction of talipes equinovarus. J Paediatr Orthop. 2000;20(4):517–23.
  • 23. Prasad P, Sen RK, Gill SS, Wardak E, Saini R. Clinico-radiological assessment and their correlation in clubfeet treated with postero-medial soft-tissue release. International Orthopaedics (SICOT). 2009;33:225–9.
  • 24. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. J Bone Joint Surg (Am). 1995;77:1477–89.
  • 25. Hutchins PM, Foster BK, Paterson DC, Cole EA. Long term results of early surgical release in clubfeet. J Bone Joint Surg (Br). 1985; 67:791–9.
  • 26. Thompson GH, Richardson AB, Westin GW. Surgical Management of resistant congenital talipes equinovarus. J Bone Joint Surg (Am). 1982;64:652–65.
  • 27. Lau JH, Meyer LC, Lau HC. Results of surgical treatment of talipes equinovarus congenita. Clin Orthop. 1989;248:219–26.
  • 28. Haasbeek JF, Weight JG. A comparison of long term results of posterior and comprehensive release in the treatment of clubfoot. J Paediatr Orthop. 1997;17(1):29-35.
  • 29. Ponseti LV, EL-Khoury GY, Ippolito E, Weinstein SL. A radiographic study of skeletal deformities in treated clubfeet. Clin Orthop. 1981;160:30–42.
  • 30. Green ADL, L1oyd-Roberts GC. Results of Early Posterior Release in Resistant Club Feet. J Bone and Joint Surg. 1985;67(B):583-93.
  • 31. Nimityongskul P, Anderson LO, Herbert DE. Surgical Treatment of Club Foot: A Comparisian of 2 Techniques. Foot & Ankle. 1992;13(3):116-124.
There are 31 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Baki Volkan Çetin 0000-0003-3231-404X

Mehmet Akif Altay

Serkan Sipahioğlu This is me

Uğur Erdem Işıkan

Celal Bozkurt

Baran Sarıkaya This is me

Cemil Ertürk

Publication Date March 22, 2019
Submission Date January 31, 2019
Acceptance Date March 6, 2019
Published in Issue Year 2019 Volume: 16 Issue: 1

Cite

Vancouver Çetin BV, Altay MA, Sipahioğlu S, Işıkan UE, Bozkurt C, Sarıkaya B, Ertürk C. Pes ekinovarus hastalarına uygulanan cerrahi tedavilerin erken klinik ve radyolojik sonuçları. Harran Üniversitesi Tıp Fakültesi Dergisi. 2019;16(1):77-81.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty