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Published byFlorence Park Modified over 9 years ago
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Neglected clubfoot deformity in a 4 year old Mongolian boy Soo-Sung Park M.D Department of Orthop. Surgery AMC Children’s hospital Seoul KOREA
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Introduction Late-presenting clubfoot deformity is rarely found, but still common in developing countries Non-op tx. usually fails and is no longer an option Surgery is necessary but can lead to problems of poor wound healing and infection Variety of skin incision & rotation flaps Staged surgery – tissue expanders, partial wound closure with healing by secondary intention, casting with suboptimal correction after surgery followed by serial manipulation Ilizarov technique w/ or w/o preliminary surgery
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Case (4Y/M) C.C: nelected clubfoot deformities P/E: Rigid Talipes equinocavovarus deformity (Lt>Rt)
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Operation Rt : SSTR(achilles tenotomy, TPAL, PF, AHR) + Ilizarov inst. Lt (Staged Op): SSTR(achilles tenotomy, TPAL, PF, AHR) Ilizarov instrumentation 1wk later
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6 weeks after deformity correction
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Removal of EF & CAST (DC 6w) Cast for 3 weeks AFO (day & night)
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Post Op 3M before leaving to Mongolia
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Discussion (recent papers) Ponseti Method (JBJS-B 2007) 17 children (24 feet), mean age 3.9 yrs. cast for 3.9 mos. Painless plantigrade foot in 16 feet ; effective method But 7/16 recurred, 8 feet failed Circumferential release & fasciocut. flap (JPO-B 2007) Case report Single staged tech. w/ double zigzag incision Age 6M~4Y, very safe and cost-effective method (J of Foot & Ankle Surg. 2006)
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Discussion Ilizarov External Fixator Role of soft tissue release before or after correction of the deformity ? Ilizarov inst. alone w/o preliminary surgery ischemic necrosis after preliminary extensive dissection (Tachdjian’s Pediatric orthop. 4 th Ed.)
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Ilizarov External Fixator Ilizarov inst. w/ minimal release recurrent arthrogrypotic clubfoot after prev. PMR Medial TN joint release ± TP tenotomy, PC (Choi el al. JBJS-B 2001) Neglected clubfoot in pts. with mean age of 19 (5~39) yrs. Limited soft tiss. dissection achilles tenot., plantar fasciotomy ; high recurrence(50%) and ankylosis(74%) ; reduce risk of NV Cx. & avoid excessive shortening of foot (Foot & Ankle international 2006) Discussion
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Conclusion STAGED Operation; SSTR followed by Ilizarov inst. is thought to be a useful method in a 4 yrs old boy Based on literature review, Ponseti method also seems to be a effective and low-cost strategy in older children
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Thank you for your attention
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