Actually conservative treatment and/or minimal invasive surgical approach is considered the gold standard in the treatment of CF all around the world. Two main italian pediatric hospitals (Bambino Gesù in Rome and Meyer in Florence) will present own series in order to realize how the two methods (Ponseti in Rome and Seringe in Florence) can be used, the right indications for each method and sharp limits as well. The aim of this study is to compare two methods for evaluating their effectiveness and their applicability. Rome series: from 1998 to 2009 pediatric hospital Bambino Gesù in Rome had treated 1350 patients with the Ponseti method (1980 feet). All feet had been scored according to Pirani classification. At age of 3–4 months, the 72% of feet treated had minimal surgery consisted in transversal tenotomy of achille's tendon. Casting for further 3 weeks and Denis-Brown splint wore full time until walking age and during the night only for 3 years after walking age. Surgery had been performed in 72% of case and surgery has been directly related to CF severity. Florence series: the Unit of Pediatric Orthopaedics Meyer Children's Hospital of Florence was born in January 2004 and therefore the series includes patients from January 2004 to December 2009. 173 patients (239 feet) were treated. Dimeglio's classification was used. At the age of 4–5 months were treated with tenotomy of Achille's tendon 51,9% of patients, mainly stage 3, and immobilization in long leg cast was used only for three weeks after surgery. Minimally invasive treatment for CF is universally considered one of the best way to correct the deformity without using the extensive surgery that often causes stiffness, pain and shoes discomfort in adulthood. The long-term results of two series are similar and this enhance our mind that not invasive method for CF treatment is effective, low-cost, with very low rate of recurrence, only if applied following strictly the protocol. In our series in fact the highest rate of recurrence concerns the missing of Denis-Brown device or early dismission of Denis-Brown as well. The adherence to the protocol is chiefly recommended by the authors when surgery is not performed and therefore the risk of recurrence is higher. The French method especially needs a skill panel of physical therapist that are in confidence with the bandage manoeuvres. Only medical operators in confidence with the methods are able to guarantee good results and a low rate of recurrence as well. For this reason the method recommended by Dr. Seringe is easy exported in geographic areas where health service and health support are well represented.Patients, Methods and Results
Discussion
In this work we report our experience, which began in 1981, with 200 patients in the correction of complex deformities (rotational and angular) of the inferior limbs by using the IIizarov method. In our case histories, we demonstrate the advantages of treatment of complex deformities using correction techniques such as epiphysiodesis operations performed in open surgery access or by using percutaneous stapling or osteotomic corrections, which in our experience are only indicated in single plane lower limb deformities. On the other hand, we demonstrate the complete validity of the IIizarov method in the progressive correction of the multi-planar deformities. Such methods allow progressive correction of the deformities in three different spatial planes, resulting, in addition to the possible improvement in the angular defects, in the simultaneous correction of the torsional defects. The critical analysis of our experience also demonstrates the possible complications inherent in the IIizarov method and which have been subdivided into further and greater complications, such as in the acute treatment of serious deformities (joint stiffness, nerve paralysis, and deep pin track infection) and in minor complications (superficial pin track infection).
Purpose: To evaluate the real effectiveness of orthopaedic prenatal diagnosis. Introduction: Sonographic early detection of fetal club foot, spine abnormalities like “spina bifida” or spondylocostal ‘” dysostosis, limb discrepancy have been often reported in prenatal orthopaedic diagnosis. But in all these cases the role of the orthopaedic surgeon is secondary: In the case reported the joined evaluation of obstetrician and orthopaedic surgeon was able to anticipate delivery, avoid a severe and constrictive amniotic band on the lover limb which might cause an amputation of the ankle and foot. Material and methods: At 25th week of pregnancy a morphologic sonographic examination was carried out in a Caucasian healthy woman. It demonstrated an healthy male fetus presenting a constrictive amniotic band on the distal right leg causing a mild oedema of the foot. Four weeks later the oedema of ankle and feet was dramatically increased and on the distal tibia an initial notch on the cortex was observed. The risk of self-amputation in utero was high, so a decision to bring forward delivery was made by a obstetrician, and paediatrician orthopaedic surgeon. In the last two weeks of uterine life the fetus was treated to obtain a satisfactory lung maturity and at 32nd week a caesarean delivery was carried out. The baby, normal, (agar score 7–9, 2750 kg.) presented a tremendous oedema of the dorsal foot causing a complete disappearance of normal shape. The skin constriction was detected on the distal leg deeply extended to the bone. An X -ray early performed showed a lesion of the anterior margin of the tibia. A Sonographic Doppler of the distal leg was able to demonstrate vascular normality so at the age of two days the baby was admitted to the plastic and reconstructive surgery for the release of the amniotic band and for reductive surgery of foot’s redundant tissue. The follow-up was good with a temporary oedema post-surgery. In 60 days the appearance of the foot was satisfactory normal. Discussion: The ultrasonographic prenatal diagnosis of an amniotic band in the reported case probably has been able to avoid an amputation of the distal lower limb. The aim of this communication is to stress the role of the prenatal diagnosis in paediatric orthopaedic to emphasize the importance of early detection of congenital skeletal abnormalities. Severe and stiff club-foot, congenital “genu recurvatum” and amniotic band as. well, ought to be treated as soon as possible. Therefore, when diagnosed in selected pregnancies, if the fetus is healthy and the lung maturity is obtained with corticosteroIds and sulfactante factor sommmlstratlon, we advise a premature delivery never before 32nd week of intrauterine life. At this stage the deformities are less stiff and every treatment (manipulation, bandage, casting) offers better results and less risk.
