CONGENITAL TALIPUS EQUINOVARUS – AN AUDIT OF RESULTS OF OPEN RELEASE WITH A VIEW TO CHANGE IN PRACTICE BASED ON EVIDENCE

Abstract

CTEV is a difficult condition to treat with chances of recurrence, re-operation rate and over correction. Recent literature based on evidence is favourable with the Ponseti management. The aim of the study was to review our surgical results over a 5-year period using the Cincinnati approach.

Children with failure of conservative serial stretching and casting for 6 months underwent open release. The records and radiographs were reviewed retrospectively from 1997–2002. 60 patients were identified with 92 feet undergoing primary sub radical releases using the Cincinnati approach in 40 male and 20 female children. The mean age at surgery was 10 months. 55 patients were idiopathic with 3 syndromal and 2 teratological.

Consultants performed > 75% of operations, with k-wire stabilisation done in 46 patients and primary wound closure in 25; the majority of wounds were left open. The timing of plaster change varied, with the majority at 2 weeks. Wound problems occurred in 4 patients (significant in 2). All patients but one wore splints for an average length of 13 months. Complication rate was 20% comprising infection, over- correction and recurrence. Re-operation rate for early recurrence was 12%. Further surgery in the form of tibialis anterior transfer and derotation osteotomy was performed on 15% and 10% of feet respectively. 6 feet in 4 patients showed signs of significant over correction.

Wound healing by secondary intention of the Cin-cinnati approach is safe. Results and complications are comparable to other series, but not to the Ponseti non-operative management. Practice is now changed to the latter based on evidence.