| Backgroud:Clubfoot deformity is one of the most common bone deformity in children, The incidence of congenital talipes equinovarus among children is above 1‰. Although all clinical workers always emphasize the necessity of early diagnosis and treatment, not a few elder children have severe deformity when they search for therapy. The treatment of stiff clubfoot in children used to be tough. Operation could not at one time completely correct the deformity of foot and ankle in three diamensions, besides it may cause complications such as cutaneous necrosis, secondary infection, postoperative scar, residual deformity, stiffness of joint and atrophy of tibialis. Especially for elder children, the treatment of stiff clubfoot seems to be a challenge to clinician, it didn't change a lot after one operation. The difficulty and risk arised when it needed second operation. Several surgical procedures have been described to treat it. Some of them include soft tissue releases, muscles transfer, others include many different osteotomies. Howerver the outcome of treatment is unsatisfactory. So, the orthopedic surgeons are constantly aim at how to stable the rectification of operation as to improve the therapeutic effect and to reduce the incidence of complications.Objective:The purpose of this study was to discuss the clinical therapeutic effect of operative fixation of wedge osteotomy with pressurized staples in treating severe clubfoot of elder children .Methods:We used wedge osteotomy and internal fixation with pressurized staples (Uni-clip staple, General Care) to treat 18 children (21 feet) who have stiff clubfoot from January 2005 to October 2008. There were 12 males and 6 females. The average age was 7.6 years ranging from 6 years to 16 years. 15 feet were at right side and 6 were left .5 were caused by accidents, 13 were congenital. According to the severity of deformity, we chose cuneiform bone, navicular bone, calcaneal bone or cuboid bone to perform the wedge osteotomy with the pressurize staple fixation. We also added with soft tissue releases and muscle tendon lengthing in various degrees.Results:Follow-up averaged 1.8 years(range 0.5-4). Normal position of the foot was achieved in our patients. Postoperative complications included mild midfoot pain in three patients and hindfoot pain in one. No superfical infections, necrosis, non-unions, or delayed unions occurred. Postoperative evaluation was based on a modified criteria by Garcean: excellent (normal shape of foot, be able to step on evenly, with no pain and normal walking) in 8 feet. Good (The deformity has almost corrected or has slight residual forefoot adduction, the joint motion of ankle is a little limited, be able to step on evenly with no pain) in 10 feet. Fair (the deformity has been improved compared with preoperative, the joint motion of ankle is limited, residual forefoot adduction or calcaneus varus doesn't need second operation) in 3 feet. There is no poor case(the deformity of foot needs second surgery combined with dislocation of subtalar joint). In the final follow-up,the rate of excellent and good is 85.7%. A statistically(p<0.05) significant change was obtained in several radiographic parameters: the talo-first metatarsal angle, calcaneo-Fourth metatarsal angle and talocalcaneal angle, two sides of the position of the osteotomy connected tightly.Conclusion:Operative fixation of wedge osteotomy with pressurized staples is a safe and effective way to treat severe clubfoot in elder children with simple handling,firm fixation and safe applying, which will not affect the bone healing and corrected angle after osteotomy is not easily missing. |
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