This paper outlines a valid and reliable, clinical method of assessing the amount of deformity in the congenital clubfoot. Clinical & MRI clubfoot scoring systems were developed to score the amount of deformity clinically & to image & score osteochondral pathology of the club-foot -MRI Total Score (MTS), MRI Hindfoot Contracture Score (MHCS), & MRI Midfoot Contracture Score (MMCS), Clinical Total Score (CTS), Clinical Hindfoot Contracture Score (CHCS), Clinical Midfoot Contracture Score (CMCS). Three independent observers tested the Clinical scoring systems Inter-observer reliability (Kappa Statistic) over one hundred consecutive clubfeet. Kappa values were CTS-0.92, CMCS-0.91, and CHCS-0.86- (almost perfect inter-observer reliability). Nineteen clubfeet were scored clinically and by thirty-eight MRI evaluations during treatment. Validity was evaluated by correlating the MRI and clinical scores (Pearson Correlation). The Pearson Correlations between clinical & MRI scores were CTS: MTS = 0.786 (P< 0.01), CHCS: MHCS = 0.712 (P< 0.01) & CMCS: MMCS = 0.651 (P< 0.01). All correlations were highly significant confirming validity.

There is neither reliability nor validity in current methods of clubfoot assessment. This paper outlines a method of assessing the amount of deformity in the congenital clubfoot deformity using six well-described simple clinical signs that has been tested & found to be both valid and reliable. A clinical clubfoot scoring system was created- Clinical Total Score (CTS)- comprised of a Clinical Hind-foot Contracture Score (CHCS) & a Clinical Midfoot Contracture Score (CMCS). One hundred consecutive congenital clubfeet were scored for clinical deformity each week during cast treatment by three independent observers. Inter-observer reliability (Kappa Statistic) of this clinical scoring system was evaluated. A clubfoot MRI protocol & scoring system were developed to visualise & score osteochondral pathology of the clubfoot -MRI Total Score (MTS)- comprised of a MRI Hindfoot Contracture Score (MHCS) and a MRI Midfoot Contracture Score (MMCS). Nineteen clubfeet were scored clinically and by thirty-eight MRI evaluations during treatment. All MRI films were scored for amount of osteochondral pathology. Validity of this clinical scoring system was evaluated by correlating the MRI and clinical scores (Pearson Correlation).

The Kappa values for inter-observer reliability were CTS-0.92, CMCS-0.91, and CHCS-0.86. All scores showed almost perfect inter-observer reliability. The Pearson Correlations between clinical & MRI scores were CTS: MTS = 0.786 (P< 0.01), CHCS: MHCS = 0.712 (P< 0.01) & CMCS: MMCS = 0.651 (P< 0.01). All correlations were highly significant confirming validity of the clinical scores.

We have developed a clinical scoring system for club-feet that is reliable and valid.

In five teaching hospitals, seventy-two patients with seventy-three bicondylar tibial plateau fractures were prospectively randomized by envelope to treatment either by AO methods (group A) or ring fixator methods (group B). Outcome measures included clinical and radiographic parameters, & HSS knee scores.

Results: Re-intervention was necessary within six months in ten group A & seven Group B patients. Forty-three procedures were performed (thirty-three Group A-ten Group B) I& D 12- 3: STSG 3-0: Quadricepsplasty 1-0; Manipulation 2–4; Muscle flap 2–0; Above knee amputation 1–0; Revision ORIF 5–1; Revision Rings 0–1; Bone graft 2–1; Bead pouch 3-0; Synovectomy 1-0; Sequestrectomy 1-0.

More patients had more septic and wound complications resulting in more need for re-intervention following ORIF.

Conclusion. For bi-condylar tibial plateau fractures (OTA 41.C) six-month HSS scores are significantly higher after treatment with Ring Fixator methods. Reintervention rates for deep sepsis/wound problems are higher with AO methods. Wound and infection complications occurring after AO treatment are more severe and require multiple procedures for control.

We have conducted a prospective randomized trial to determine the outcomes of treatment by

Open reduction and internal fixation or

We report our early findings on re-intervention rates for complications.

In five teaching hospitals, seventy-two patients with seventy-three bi-condylar tibial plateau fractures were prospectively randomized by envelope to treatment either by AO methods (group A) or ring fixator methods (group B). Outcome measures included clinical and radiographic parameters, & HSS knee scores. Randomization gave the following demographics

Re-intervention was necessary within six months in ten group A & seven Group B patients. Forty-three procedures were performed (thirty-three Group A-ten Group B) I& D 12- 3: STSG 3-0: Quadricepsplasty 1-0; Manipulation 2-4; Muscle flap 2-0; Above knee amputation 1-0; Revision ORIF 5-1; Revision Rings 0-1; Bone graft 2-1; Bead pouch 3-0; Synovectomy 1-0; Sequestrectomy 1-0.

More patients had more septic and wound complications resulting in more need for re-intervention following ORIF.

For bi-condylar tibial plateau fractures (OTA 41.C) six-month HSS scores are significantly higher after treatment with Ring Fixator methods. Reintervention rates for deep sepsis/wound problems are higher with AO methods. Wound and infection complications occurring after AO treatment are more severe and require multiple procedures for control.

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