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At least 451 records · Page 25Linked to original sources
PubMed1999

Postoperative blood loss into plaster casts after clubfoot surgery: an experimental model.

With major surgery in mind, a simple experimental model was used to study the potential blood loss into plaster of Paris casts. Three lower limb models were used to represent a 3-year-old, a 1-year-old, and a 6-month-old. Two thicknesses of plaster were compared in terms of blood volume required to produce staining on the surface of the cast. Whole blood from the laboratory was infused onto the plaster models at various rates. While allowing for the limitations of the model, the blood volume required before staining through the plaster when three plaster rolls were used was an average of 160 mL in the 6-month-old model and 310 mL in the 3-year-old modal, representing 31.4% and 29.5% of total blood volume, respectively. When only two rolls of plaster of Paris were used, an average of 80 mL in the 6-month-old and 180 mL in the 3-year-old model were lost, representing 15.7% and 17% of total blood volume, respectively. This potential blood loss should be borne in mind during major pediatric foot surgery. The use of drains, releasing the tourniquet before wound closure, and casting with two rather than three rolls of plaster are suggested precautions.

Age Factors↗
PubMed1999

Calcaneocuboid malalignment in clubfoot.

In a series of 179 clubfeet treated surgically with a follow-up of 3 to 14 years, the clinical significance of calcaneocuboid malalignment was assessed on the basis of a standardized anteroposterior radiograph. The revision rate was 15% and the clinical requirement for a further soft tissue release was related to the talocalcaneal and calcaneocuboid angles. Calcaneocuboid malalignment does not have an adverse effect on the good prognosis of an otherwise well-corrected foot and does not alter the surgery needed to improve a clearly uncorrected foot. When talocalcaneal correction is doubtful, calcaneocuboid malalignment should tilt the balance toward a revision and is of value when the navicular has yet to ossify. Surgical release of the calcaneocuboid joint is unnecessary, particularly the lateral dissection, provided that the medial and subtalar dissection is complete.

Adolescent↗
PubMedDate not supplied

Accurate determination of cast weight for neonates with clubfoot.

The purpose of this study was to determine changes in cast weight during the first 48 hours after application so that the true weight of a neonate can be estimated without the need for removing the cast. Five types of cast materials were compared. Cast weight measurements were obtained before and after application and at intervals during 48 hours. Final cast weight averaged 107.5% of dry weight for plaster and 99% of dry weight for synthetic cast materials. For very low birth weight infants, the difference between the initial wet weight of plaster of Paris and its final dry weight may be significant for calculating drug and fluid dosages. The weight of an infant can now be calculated without the necessity of cast removal.

Casts, Surgical↗
PubMedDate not supplied

Evaluation of the hemi-Cincinnati incision for posteromedial soft-tissue release in clubfoot.

Posteromedial soft-tissue release operations were performed on 42 idiopathic clubfeet in children younger than 2 years of age through the medial half of the Cincinnati incision (the hemi-Cincinnati incision). This incision gave adequate exposure to all structures to be released. Wound closure was possible in all 42 feet without having to hold the foot in plantarflexion or inversion. Wound healing was satisfactory in the majority of instances and 81% of the scars, assessed 9 months after the operation, were graded as excellent or good. The scar is located in an area of the foot that can be concealed easily and should a more radical soft-tissue operation be needed later, the same incision can be extended easily. The authors recommend this incision as the incision of choice for performing posteromedial soft-tissue release operations on clubfeet in children younger than 2 years of age.

Achilles Tendon↗
PubMed2000

[Surgical treatment of congenital clubfoot with constriction band syndrome].

Twelve feet in 11 patients with constriction band syndrome age ranging from 3 to 18 months (mean age 11 months) were evaluated in this study. The constriction band was located at the in the calf, at distal, media and proximal third levels. All these patients were treated surgically by a wide peritalar release using the Cincinnati incision, followed by a two-stage Z-skin plasty. Both clinical and radiological results were evaluated. In our material an excellent result was achieved in 1 case, good results in 3 cases, satisfactory in 4 cases and poor in the remaining four cases. Very good and good results were achieved in feet with shallow bands type II and III, while poor results were found in feet with deep constriction band type I. Early surgical treatment followed by serial casting leads to better functional results.

Amniotic Band Syndrome↗
PubMed2000

[Analysis of intraoperative complications during surgery for clubfoot].

The paper presents an analysis of the complications accompanying surgical treatment of congenital club feet. In the year 1966-1993 178 feet in 149 patients aged ranging from 5 to 140 months (mean age 17.5 months. In 57 cases a posterior capsulotomy with lengthening of the Achilles tendon was performed, in 121 cases a total sub-talar release was performed. Complications wee classified as intra-operative and early and late post-operative. A total of 85 complications in 44 patients were observed, which amount to 44.7% of the cases. In 16 cases intra-operative complications were a result of technical mistakes during the procedure (severing of a tendon, blood vessel or joint). Post-op complications were due to wound healing disturbances in 28 cases and necrotic changes in 12 cases. Sub-talar release gives a larger number of complications (55.4%) compared to posterior capsulotomy with Achilles tendon lengthening (31.6%).

Child↗
PubMed2001

[The role of posterior release in the treatment program for congenital clubfoot].

The aim of this paper was to assess the utility of this procedure and to define it's role in treatment of congenital clubfeet. The material comprises 123 children, among whom 154 feet were treated by posterior release. The age of the patients ranged from 5 to 36 months (average age: 16 months). The procedure involved the lengthening of the Achilles tendon in the sagittal plane, partial resection or transverse dissection of the articular capsule of the ankle joint. In selected cases lengthening of the tendon of the extensor hallucis muscle was performed and sometimes of the posticus muscle. The described procedure was performed in all cases where all forefoot components of the deformity were found, as well as an equines position of the foot. A group of 87 patients (70.7%), among whom posterior release was performed in 101 feet (65.6%). The follow-up time ranged from 5 to 15 years (average: 12.3 years). Results were assessed according to the classification by Magone et al. Very good results (95-100 points) were achieved in 27 feet (26.8%), good results (80-89 points) were found in 40 feet (39.6%), satisfactory (70-79 points) in 25 feet (24.7%), and bad results (less than 70 points) in 9 feet (8.9%). Basing on their own experience the authors' believe this procedure is very useful in treatment of congenital clubfeet. It's therapeutic usefulness is at it's best when deformities of the forefoot have been conservatively corrected. The extent of posterior release depends on the severity of the deformity.

Achilles Tendon↗
PubMed2001

[Corrective surgical procedures as repeated treatment of residual clubfoot].

The authors present an analysis of failed surgery in 139 patients with congenital clubfeet. There were 72 feet, which required repeated surgical procedures after primary treatment. Twelve feet were treated by posterior release, and 65 by postero-medial release. The repeated reconstruction was performed at a mean age of 3.6 years. No very good results were found in either group at final follow-up, done according to the Magone et al. classification. In the first group treated by posterior release god results were noted in 53.3% of the cases, sufficient in 43.1% and poor in 38.5%. The authors underline that the final results depend on early consequent conservative treatment, use of adequate operating techniques and cooperation between child, parents, physician and orthotic specialist.

Child↗
PubMed2001

[The possibilities of operative treatment of residual and recurrent congenital clubfoot].

The paper presents 14 different surgical procedures recommended in literature for the correction of singular deformed elements of congenital clubfeet. Basing on clinical material collected from patients treated during the last five years, the authors introduce the application of the presented procedures for the correction of residual and recurrent deformities occurring in congenital clubfeet. Basing on their own experience, knowledge and available publications the authors attempt to assess the indications for each particular procedure and their mutual connections, which depend on: the kind and extend of the deformity, its location and the age of the child.

Child, Preschool↗
PubMed2001

[The historical evolution of one-stage surgical treatment of congenital clubfoot in newborns].

The author presents a historical overview of the evolution of surgical treatment of congenital clubfeet, focussing in particular on the last 30 years. The paper reviews the pathological and biomechanical problems related to the surgical procedures introduced by Turco, McKay and Simons, as well as indications for procedures from a postero-lateral and Cincinnati approach.

Clubfoot↗
PubMed2001

Does functional treatment of idiopathic clubfoot reduce the indication for surgery? Call for a widely accepted rating system.

We present our experience of treatment by physiotherapy, continuous passive motion and strapping in a series of 100 clubfeet classified on a scale of severity according to Dimeglio. Twenty-five percent were good after conservative treatment, and 75% required an operation. There were no recurrences or additional procedures. Before the introduction of the functional treatment in our department, 100% required some sort of surgical intervention and 51% required an additional procedure. In comparison with the results published by Dimeglio et al., the greatest discordance is observed in grade 2 clubfeet.

Clubfoot↗