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Does Short-term Application of an Ilizarov Frame with Transfixion Pins Correct Relapsed Clubfoot in Children?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Treatment of relapsed clubfoot after soft tissue release in children is difficult because of the high recurrence rate and related complications. Even though the Ilizarov method is used for soft tissue distraction, there is a high incidence of recurrence after removal of the Ilizarov frame owing to previous contracture of soft tissue and a skin scar.

Questions/Purposes

We asked (1) whether transfixation of midfoot joints by temporary K wires during the consolidation stage after short-term application of an Ilizarov frame would maintain correction of the relapsed clubfoot clinicoradiologically and (2) whether this method would reduce the rate of recurrence and related complications in patients with a skin scar from previous surgery.

Methods

We retrospectively reviewed 18 patients (19 feet) with relapsed clubfeet who underwent correction by soft tissue distraction using an Ilizarov ring fixator, between March 2005 and June 2008. The mean age of the patients was 8 ± 2 years (range, 4–15 years). K wire fixation for the midfoot joints combined with a below-knee cast were used during the consolidation stage. The minimum followup was 2 years (mean, 4.5 years; range, 2–6 years).

Results

The average duration of frame application was 5 weeks; the mean duration of treatment was 11 weeks. At last followup, 16 of 19 feet were painless and plantigrade and only three of 19 feet had recurrence. The mean preoperative clinical American Foot and Ankle Society (AOFAS) score had increased at last followup (57 versus 81). The values of the AP talocalcaneal, AP talo-first metatarsal, and lateral calcaneo-first metatarsal angles improved after treatment. The three recurrent clubfeet were treated by corrective osteotomies and Ilizarov frame application.

Conclusion

This method could maintain the correction of relapsed clubfoot in children and reduce the recurrence rate and complications regardless of the presence of a skin scar owing to previous surgery.

Level of Evidence

Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Mandar Vikas Agashe MS, Hanna Lee MD, and Hyeok Nam Kwon MD for assistance with data collection, writing the primary manuscript, and manuscript editing.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Institute for Rare Diseases, Guro Hospital, Korea University Medical College, 80 Guro-Dong, Guro-Gu, Seoul, 152-703, Korea

    Mohamed Ahmed Refai MD, Sang-Heon Song MD & Hae-Ryong Song MD, PhD

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  1. Mohamed Ahmed Refai MD
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  2. Sang-Heon Song MD
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  3. Hae-Ryong Song MD, PhD
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Corresponding author

Correspondence to Hae-Ryong Song MD, PhD.

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Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

The institution of one or more of the authors (MAR, SHS, HRS) has received, in any one year, funding from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A110416).

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Refai, M.A., Song, SH. & Song, HR. Does Short-term Application of an Ilizarov Frame with Transfixion Pins Correct Relapsed Clubfoot in Children?. Clin Orthop Relat Res 470, 1992–1999 (2012). https://doi.org/10.1007/s11999-012-2289-4

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  • DOI: https://doi.org/10.1007/s11999-012-2289-4

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