At our institution surgical correction of symptomatic
flat foot deformities in children has been guided by a paradigm in
which radiographs and pedobarography are used in the assessment
of outcome following treatment. Retrospective review of children
with symptomatic flat feet who had undergone surgical correction
was performed to assess the outcome and establish the relationship
between the static alignment and the dynamic loading of the foot. A total of 17 children (21 feet) were assessed before and after
correction of soft-tissue contractures and lateral column lengthening,
using standardised radiological and pedobarographic techniques for
which normative data were available. We found significantly improved static segmental alignment of
the foot, significantly improved mediolateral dimension foot loading,
and worsened fore-aft foot loading, following surgical treatment.
Only four significant associations were found between radiological
measures of static segmental alignment and dynamic loading of the foot. Weakness of the plantar flexors of the ankle was a common post-operative
finding. Surgeons should be judicious in the magnitude of lengthening
of the plantar flexors that is undertaken and use techniques that
minimise subsequent weakening of this muscle group. Cite this article:
We have reviewed our experience of the removal of deep extremity orthopaedic implants in children to establish the nature, rate and risk of complications associated with this procedure. A retrospective review was performed of 801 children who had 1223 implants inserted and subsequently removed over a period of 17 years. Bivariate analysis of possible predictors including clinical factors, complications associated with implant insertion and indications for removal and the complications encountered at removal was performed. A logistical regression model was then constructed using those predictors which were significantly associated with surgical complications from the bivariate analyses. Odds ratios estimated in the logistical regression models were converted to risk ratios. The overall rate of complications after removal of the implant was 12.5% (100 complications in 801 patients), with 48 (6.0%) major and 52 (6.5%) minor. Children with a complication after insertion of the initial implant or with a non-elective indication for removal, a neuromuscular disease associated with a seizure disorder or a neuromuscular disease in those unable to walk, had a significantly greater chance of having a major complication after removal of the implant. Children with all four of these predictors were 14.6 times more likely to have a major complication.
