The purpose of our study was to independently assess the modified Herring lateral pillar classification. 35 standardised true antero-posterior radiographs of children in various stages of fragmentation were independently assessed by 6 senior observers on 2 separate occasions (6 weeks apart). Kappa analysis was used to assess the inter and intraobserver agreement between observations made. Intraobserver analysis revealed at best only moderate agreement for two observers. 3 observers showed fair consistency, whilst 1 remaining observer showed poor consistency between repeated observations (p<0.01). The highest scores for interobserver agreement varying between moderate to good could only be established between 2 observers. For the remaining observers results were just fair (p<0.01). This stdy highlights the lack of agreement between senior clinicians when applying the modified LPC. This clearly has clinical implications. To our knowledge this is the first time the modified lateral pillar classification has been independently tested for its reproducibility by a specialist orthopaedic unit.Methods and results
Conclusion
The purpose of the present study is to evaluate the early results of the Ponseti method when used for the treatment of idiopathic clubfoot among the population of the island of Crete. Fourteen consecutive infants (twenty-one feet) with idiopathic clubfoot deformity were managed with the Ponseti method and were retrospectively reviewed at a minimum of six months. The severity of the foot deformity was classified according to the grading system of Pirani et al. The number of casts required to achieve correction was compared with published data for the treatment of idiopathic clubfoot. Recurrent clubfoot deformities or complications during treatment were recorded. Initial correction was achieved with a mean of 5.2 casts. Tenotomy and Dennis-Browne braces followed the cast applications. One foot had a relapse which was then treated by a repeat tenotomy at the age of 8 months. Two children abandoned the protocol because the parents could not comply with bracing. No extensive surgery is needed so far and all feet are flexible and pain free. X-rays when taken showed the talo-calac-neal angle within normal limits. We support the use of the Ponseti method for the treatment of idiopathic clubfoot, since it can deliver flexible physiological feet, in the outpatient environment, thus avoiding the consequences of extensive open surgery.
We reviewed in retrospect the preliminary results of ilizarov type fixator for the treatment of severely comminuted calcaneal fractures. Between February 2006 and December 2008 we dealt with six severely comminuted calcaneal fractures in six patients. Two of which were open type Gustillo IIIa. Mean age was 43 years old(28–56 years old) two of which were female and four male. Preoperatively all fractures were checked by x-ray and computed tomography and were all rated as Sanders type IV. The open fractures were treated within 6 hours and the closed ones the following day. After the positioning of the ilizarov tibial and foot frame, an indirect reduction was achieved using the Ilizarov olive wires. Mean follow up was 20 months (9 to 36 months). Results were rated as very good in two patients (33%), good in three patients (50%) and fair in one (17%). So far no re-operation has been required and four of the patients are back to work. We conclude that the ilizarov system, even with indirect reduction can give very promising results in severely comminuted and complex calcaneal fractures whereas internal fixation has questionable success and many complications
