Aim: This study was designed to investigate the association between clinical assessment International Clubfoot Study Group (ICFSG) and quantitative gait data of the children

Methods: Nineteen patients with 30 surgically treated clubfoot were included in this study. Bilateral involvement was present in 11. Average age was 9 years (range 6–14 years) at the time of last follow-up. Patients were treated with different surgical techniques at early childhood period. At the final follow-up they were evaluated according to ICFSG clinical scale. This rating system is based on three main subgroups of evaluation as morphologic evaluation, functional evaluation and radiological evaluation. The maximum score is 12 in morphologic evaluation, 36 in functional evaluation and 12 in radiological evaluation. The total score is from 0 for a perfect result to 60 for the worst result. Further, a total score of 0–5 is rated as excellent, 6–15 as good, 16–30 as fair and over 30 as poor. Quantitative gait data was collected with the Vicon 370 (Oxford Metrics, Oxford, UK). Two force plates (Bertec, Colombus, Ohio, USA) were used for kinetic analysis. All time-distance (walking velocity, cadence, step time, step length, double support time), kinematic (joint rotation angles of pelvis, hip, knee and ankle in sagittal, coronal and transverse planes) and kinetic (ground reaction forces, moments and powers of hip, knee and ankle) data were processed using Vicon Clinical Manager software package. Spearman correlation analysis was used to evaluate if there is a correlation between total clinical score and gait parameters.

Results: Average ICSG score was 8.63 (range 1–29). Outcome was excellent in 16, good in 8 and fair in 6 patients according to ICSG. There was a significant correlation between total ICSG score and walking velocity (rs=−0.195, p=0.004), step length (rs=−0.476, p=0.019), pelvic excursion in sagittal plane (rs=−0.429, p=0.026), hip excursion in sagittal plane (rs=−0.511, p=0.006), knee excursion in sagittal plane (rs=−0.486, p=0.019), Ankle excursion in sagital plane (rs=−0.413, p=0.040), peak ankle plantar flexion moment (rs=−0.600, p=0.039), peak ankle plantar flexion power (rs=−0.487, p=0.025). When we compare the gait parameters between groups only foot progression angle showed a significant difference (p=0.031).

Conclusion: ICFSG score is a successful method to follow outcome in patients with surgically treated clubfoot. ICFSG score is correlated with many kinematic and kinetic gait data however foot progression angle is the only parameter predicting outcome in children with surgically treated idiopathic clubfoot. Quantitative gait analysis may help to define the liable factors of the functional deficits, and to prescribe novel rehabilitation techniques to enable better outcome for children with clubfeet.

Aim: Surgical treatment for idiopathic clubfeet aims to realign the foot and allow plantigrade weight bearing with adequate joint motion. In spite of satisfying clinical and radiological results for both the physician and the parents shortly after the operation, deterioration may occur years after the surgery. The aim of this study was to evaluate gait characteristics of children with surgically treated unilateral clubfoot and had good clinical outcome.

Methods: Twelve children (mean age 5.9±2.3 years (4–9)) with surgically treated unilateral clubfoot before age one and twelve age matched healthy children were included in the study. Foot length, calf circumference, ankle range of motion and radiographic measurements were recorded. Quantitative gait data was collected with the Vicon 370 (Oxford Metrics, Oxford, UK). Two force plates (Bertec, Colombus, Ohio, USA) were used for kinetic analysis. All time-distance (walking velocity, cadence, step time, step length, double support time), kinematic (joint rotation angles of pelvis, hip, knee and ankle in sagittal, coronal and transverse planes) and kinetic (ground reaction forces, moments and powers of hip, knee and ankle) data were processed using Vicon Clinical Manager software package.

Results: Foot length of the operated side was shorter than the unaffected side but the difference was not significant (p> 0.05). Calf circumference and ankle range of motion were significantly less than the unaffected side (p< 0.05). Quantitative gait data revealed that children with clubfoot had slower walking velocity (0.75±0.25 versus 1.02±0.18 m/sec, p=0.001), shorter stride length (0.72±0.23 versus 0.91±0.05 meters, p=0.001) and less ankle plantar flexor moment (0.73±0.22 versus 0.88±0.11 m/sec, p=0.007) than healthy children. Unaffected side showed increased pelvic excursions and medio-lateral ground reaction forces as well as decreased ankle and hip motion in sagittal plane.

Conclusion: We detect various deviations in gait parameters even in so called well treated patients according to radiological and clinical criteria. Alterations in the unaffected foot may be the result of the subclinical involvement of the unaffected foot by disease as well as the compensatory mechanisms. These gait deviations may lead long-term morbidity later in adulthood.

Aim: The aim of this study is to evaluate the results of conservative treatment of Neer type III and IV fractures of the proximal humerus in patients who refused surgery or could not undergo surgery because of medical conditions.

Methods: Eighteen patients were included in the study. There were 8 Neer type III and 10 Neer type IV fractures. None of the patients had head-splitting fractures. Treatment and follow-up protocols were standardized for all cases. All patients were assessed for Constant scores in postoperative first year and at latest follow-up. Patients were divided into two groups regarding their age. Patients of 65 years or under that were named as group A (7 patients), while patients over 65 years old were named as group B (11 patients). Patients were further divided into two groups regarding their Constant scores. Patients with less than 70 points were named as group I (12 patients), while patients with 70 points or higher were named as group II (6 patients). Statistical analysis was performed using student’s t test, chi-square test and Fischer exact test.

Results: Mean age was 68.2± 13.8(39–90) years. Mean follow-up was 34.5±12.4 (18–56) months. Mean Constant score was 56.1±14.7 (26–76) points in postoperative first year follow-up. Mean Constant score was 59.7±13.9 (36–84) points at latest follow-up. Osteonecrosis of the humeral head was dedected in 5 patients. There was no significant difference between group A and group B regarding Constant scores (p=0.233). There was no significant difference between group I and group II regarding age (p=0.178). There was no significant difference between Neer type III and Neer type IV fractures regarding age (p=0.176) and Constant scores (p=0.075). Mean postoperative first year Constant score of Group A patients with type III fractures was significantly higher when compared to group B patients with type IV fractures (p=0.046). Constant scores at latest follow-up (p=0.261) and fracture types (p=0.618) were similar between patients with osteonecrosis and without osteonecrosis.

Conclusions: Results of conservative treatment of these fractures are satisfactory even in elderly patients. Similar functional results as in younger patients can be achieved with proper and accurate treatment. While fracture type individually does not have an influence on functional results, functional results are better in young patients with type III fractures then in old patients with type IV fractures.