Abstract
In the most severe clubfeet, especially in relapse, traditional operations are not helpful any longer. In these cases the Ilizarov method (IM) can correct even the worst deformities by gradual correction. Up to the age of about eight years, traditional operations can be performed in most cases of relapsed clubfoot. A disadvantage of the traditional operation is the shortening of the foot if a wedge is resected. With the IM the patient need not be immobilised postoperatively for a long period, which is important especially for those children with neurological diseases. We report on our 18 years experience with the IM.
We have operated 99 clubfeet with the IM. The first 91 consecutive cases in 79 patients are included in this retrospective study. The mean age of our patients was 14.2 years. The mean follow-up was two years, five months. The etiology was 28 congenital, 51 neurological, five rheumatological and seven with posttraumatic clubfeet. The mean number of operations per patient before presenting to us was 1.6 (range 0 to 8). The mean healing time – the number of days from application of the external fixator until its removal – was 115 days. Using the classification of Dimeglio we found 12 type 3 feet and 79 type 4 feet (stiff-stiff).
In 37 feet we observed a superficial infection, in seven a deep infection, and an ostitis in one. At the end of a seven-year follow-up period, clinical, radiological and laboratory tests of the patient with ostitis showed no signs of infection. In the beginning we had some torn wires, but this was a problem that could be solved with increasing experience.
We classify the patients into three groups. Feet that have a normal or almost normal shape and permit weight bearing and walking without pain are rated as good. Radiologically the foot is well corrected. A residual deformity without skin damage or complaints is rated as fair. A relapse, overcorrection or severely restricted walking capacity is rated as bad.
In our study we found 52 good, 33 fair and 6 bad results. All feet with a preoperative infection due to long lasting skin breakdown and ostitis healed well during treatment with an external fixator.
The IM is a safe procedure even in the most severe cases and allows correction if traditional methods can no longer be used. The results show that many good and at least fair results can be achieved. Normal function cannot be expected in these severely deformed feet, but the aim is to allow weight bearing and walking even in severe cases. The IM is especially helpful in neurologically relapsed clubfeet. The IM is an efficient tool in the hands of an experienced orthopaedic paediatric surgeon.
The abstracts were prepared by David P. Davlin. Correspondence should be addressed to him at the Orthopedic Clinic Bulovka, Budínova 2, 18081 Prague 8, Czech Republic.
