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.

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.

Introduction

Previous studies have demonstrated the need of accurate reduction of ankle syndesmosis. Measurement of syndesmosis is difficult on plain radiographs. Recently, a difference of 2mm in anterior and posterior measurements at incisura of the inferior tibio-fibular joint on CT has been described as a measure of malreduction (depicted as ‘G’ for ease of description). Our practice changed towards routine post operative bilateral CT following syndesmosis fixation to assess the reduction and identify potential problems at an early stage. The aim of this primarily radiological study was to determine if the use of bilateral cross sectional imaging brings additional benefit above the more conventional practice of unilateral imaging.

We audited all patients who underwent Foot and Ankle surgery at the University Hospital of Wales over one financial year (April 2007 – March 2008).

Patients were identified from the hospital OPCS-4 coding system and all scheduled and unscheduled visits to hospital investigated. Both trauma and elective patients were included. Patients were followed up for a mean period of 9 months (Range 1–14 months) following surgery.

The records for 1052 patients were evaluated. Of these, 77% were elective cases and 23% were trauma related. Overall about 10 % of our foot and ankle patients (100/1052) either attended the A& E Department or had an unplanned clinic visit at some stage of their follow up. Three quarters of these patients were admitted to hospital (median stay 1 day, range 1–51 days).

Twenty five patients (24 A& E; 1 medical) simply re-attended, but were not admitted. The majority of these (58%) had plaster-related problems (8\24) or superficial wound infections (6/24). The remaining patients presented with pain around the operated area, and were discharged after investigation. One patient presented to the physicians 44 days after excision of a Morton’s neuroma with a DVT.

Seventy five patients (7%) were re-admitted to hospital. Two were admitted under the physicians: one with a pulmonary embolus (30 days post ORIF ankle) and one following a cardiac arrest (20 days post ORIF ankle). Out of the remainder 34 patients had planned removal of metalwork, 9 patients had metalwork removed because of infection and 21 patients had soft-tissue infection requiring antibiotics or debridement. Overall, 9 patients underwent revision surgery (0.85%).

The overall infection and thromboembolic rate was 3.42 %(6 A& E + 30 T& O/1052) and 0.28% (1A& E + 2 medical/1052) respectively.

Purpose of study: The UMEX frame was developed from the Joshi external fixator, being first used in the UK in 2004. It corrects deformity by gradual distraction and manipulation. We report the outcomes of a two centre combined experience of the UMEX frame for the treatment of complex congenital foot deformities.

Method: The frame was used in the management of 27 complex foot disorders, the majority of which were resistant club feet. All patients had at least 18 month follow up.

Results: Good deformity correction was achieved in all cases, with a plantigrade foot immediately post-treatment. However, minor degrees of relapse have been noted when the strict postoperative regimen was not followed.

Conclusions: The application of external fixators for the correction of foot deformities can be a complex procedure for the surgeon, and cumbersome for the patient. This frame is simple to apply and manage and allows multi-planar deformity correction in one stage. Our experience and patient outcome data suggest that this technique is a useful surgical option for the Paediatric Orthopaedic surgeon dealing with a relapsed club foot and other complex foot deformities.

Introduction Pan-talar nailing for ankle arthrodesis has been advocated as a salvage procedure for post-traumatic arthrosis and Charcot’s joint. This study evaluates the outcome of pan-talar nails over a 4-year period.

Method This is a retrospective study of 11 patients (13 ankles) who underwent pan-talar nailing between 2000 and 2004. Various factors including patient demographics, indications for surgery, operation details, complications, time to fusion and need for re-operation were recorded. Nine were reviewed at a mean follow-up of 22 months for clinical and radiological assessment; two patients had died. American Orthopaedic Foot and Ankle (AOFAS) hindfoot and SF-36 scoring systems were also used for evaluation.

Results There were seven males and four females, with a mean age of 57 and 71 years, respectively. Eight patients had a pre-operative diagnosis of Charcot’s joint, one avascular necrosis of talus, one fixed deformity with polio, and one following fracture non-union.

All 13 nails were locked at both ends. The average duration of operation was 2 hours and tourniquet time 1 hour 8 minutes. All patients were kept non-weight bearing in cast post-operatively for an average of 6 weeks.

There were two cases of wound infection, one pulmonary embolism and one calcaneal fracture with infected non-union, which was treated with external fixation. There were no cases of nerve damage or septic arthritis.

All nine patients were satisfied with the operation outcome at follow-up with a mean fusion duration of 28 weeks and an average AOFAS score of 75.

Conclusion We conclude from this study that pan-talar nailing when performed for ankle arthrodesis as a salvage procedure produces a high rate of fusion with fewer complications.

We report our initial experience with the Universal Mini External Fixator (UMEX) frame for the treatment of complex congenital foot deformities. This new frame is simple to apply and manage. It provides for multiplanar deformity correction in one stage.

The application of external fixators for the correction of foot deformities can be a complex procedure for the surgeon and cumbersome for the patient. Currently, five patients (mean age 10 years, range 4–18) have undergone application of this frame and have completed treatment. We illustrate the ease of its application, potential complications and the early clinical outcomes.

In the last six months 6 cases of subacute epiphyseal osteomyelitis have presented to the Paediatric Orthopaedic Department at the University Hospital of Wales, Cardiff. We present a clinical review of these cases illustrating the salient points in their varied presentation and management, together with the results of a retrospective analysis of the incidence of this rare condition. We ask “is there an increasing incidence of this rare condition or have we become increasingly aware of this potential diagnosis in children?”