Complex congenital foot deformities pose a challenge to the surgeon due to poor results after extensive surgery. We report the clinical outcomes of children with complex congenital foot deformities treated with UMEX® (Universal mini-external fixator System) frames. This is a prospective review of our experience in patients treated in this way, from 2004 to 2011. The indications for treatment included resistant/recurrent Congenital Talipes Equino Varus (CTEV), cavo-varus deformity secondary to Charcot-Marie-Tooth disease, arthrogryposis, fibular hemimelia and other congenital abnormalities. A total of 32 children (35 feet) have been treated, out of which 22 were male and 10 were female patients. Age at surgery ranged from 3 to 15 years (median age – 7 years). Three patients underwent bilateral procedures; the reminder (29 patients) underwent unilateral foot operations. Twenty-eight patients had undergone previous surgery including soft-tissue and/or bony corrective procedures. The frames were removed at an average of 69 days after application, and the patients spent a further 6 weeks in a walking cast. Good functional outcomes were noted in 26 patients in the first postoperative year and in 19 patients in the fifth postoperative year. Further operations were needed in 10 patients. Complications occurred in 10 patients, predominantly pin-site infections and 1 case of bony overgrowth at pin-site and 1 of proximal tibio-fibular diastasis. This is a simple fixator to use with a short learning curve. In groups of patients with complex congenital abnormalities, we achieved good functional outcome with low-complication rates.
Modular femoral necks have shown promising clinical results in total hip arthroplasty (THA) to optimize offset, rotation, and leg length. Given the wide variety of proximal femoral morphology, fine-tuning these kinematic parameters can help decrease femoroacetabular impingement, decrease wear rates and help prevent dislocations. Yet, additional implant junctions introduce additional mechanisms of failure. We present two patients who developed an abnormal soft tissue reaction consistent with a metal hypersensitivity reaction at a modular femoral neck/stem junction requiring revision arthroplasty. Two patients underwent THA for primary osteoarthritis with the same series of components: 50 mm shell, a 36 mm highly-crosslinked polyethylene liner, uncemented titanium alloy modular stem with a 130 degree Cobalt Chromium (CoCr) modular femoral neck, and 36 mm CoCr head with a +5-mm offset. Patient 1 was a 63 year-old female who had an uneventful post-operative course but presented seven months later with progressive pain in the left hip. Patient 2 was an 80 year-old female who did well post-operatively, but presented with limp and persistent pain at 10 months post-op. An initial evaluation of a painful THA to rule out aseptic loosening, infection, mal-positioning, loosening and osteolysis included radiographs, lab work (CBC, ESR, CRP, Cobalt & Chromium levels) and Metal Artifact Reduction Sequence (MARS) MRI.Introduction
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We report the clinical outcomes of children with complex congenital foot deformities treated with UMEX® mini-external fixators. This is a prospective review of our experience in patients treated in this way, from 2004. The indications for treatment were resistant/recurrent Congenital Talus Equina Varus(CTEV), cavo-varus deformity secondary to Charcot-Marie-Tooth disease, arthrogryposis, fibular hemimelia and other congenital abnormalities. In addition, one patient underwent this treatment since he was allergic to casting material. A total of 32 children (35 feet) have been treated, with a male to female ratio of 22:10 respectively. The patient-age at operation ranged between 3 and 15 years (median age −7 years). Three patients underwent bilateral procedures and 29 patients underwent unilateral foot operations. Twenty-eight patients underwent previous soft-tissue and bony corrective operations with serial casting. The frames were removed at an average of 69 days after application with a further 6 weeks in a walking cast. Seventy-nine percent of the patients had good functional outcome. Further operations were needed in 10 patients. Complications occurred in 10 patients, including pin-site infections, bony overgrowth at pin-site and proximal tibio-fibular diastasis. In conclusion, this is a simple fixator to use with a small learning curve. In groups of patients with complex congenital abnormalities, we achieved good functional outcome with low-complication rates.
