RESUMO
The objective of this clinical appraisal was to assess the clinical-radiological results of ankle deformity correction secondary to physeal injury, utilizing the methods based on the age of the child, site & severity of the deformity, remaining growth potential, condition of the soft tissue envelop and integrity of neurovascular status. Fifteen subjects ≤ 16 years of age, with angular deformities of the ankle secondary to physeal injury, were included. Deformities secondary to infection and pathological fractures were excluded. Demographic data, type of injury, treatment method, and follow-up were recorded from the case files. Treatment categories included osteotomies for acute correction (> 10 years) and growth modulation (≤ 10 years). Male to female ratio was 7:8, with an average age of 11.8 ± 2.31 years (range 9-16 years). The right and left ratio was 7:8. Mean duration of follow-up was 1 year and 4 months. Gradual deformity correction was done in 2 cases utilizing the principle of growth modulation, while acute correction by osteotomy was done in 13 cases. The average pre-operative ankle deformity was 20.8 ± 3.11 degrees (Range -25 to 24 degrees). Radiological union was attained at a mean of 11 weeks (8-24). Nine patients achieved neutral ankle alignment. The mean residual varus was 2.3°, and the valgus was 4°. There was a statistically significant improvement of the AOFAS score by 17 points from a mean pre-operative score of 57 (44-84) to 74 (56-100) points at the final follow-up (p-value < 0.001). The average pre-operative shortening was 2.36 ± 0.21 cm, which was completely corrected in 9 individuals. Management of angular deformities around the ankle calls attention to correcting the resultant angular deformity and/or limb length disparity, utilizing acute or gradual correction. A successful outcome depends on early recognition and patient-specific treatment of paediatric ankle fracture patterns. Correlating the results of our study with the available literature, we feel that both acute or gradual correction for angular deformities around the ankle is a feasible solution as long as principles of deformity correction are adhered to. Techniques for salvaging and restoring the viability of injured physeal plate warrant additional research.
RESUMO
BACKGROUND: The management of adolescent femur fractures continues to evolve and remains controversial. Currently, operative fixation methods are favoured, offering options such as external fixator, flexible and locked intramedullary nailing, compression and locked plating. Our study aims to introduce a novel approach for treating adolescent femoral shaft fractures by combining an external fixator with an elastic stable intramedullary nail. MATERIAL AND METHODS: We included 32 patients aged 11-16 years with femoral shaft fractures treated using an external fixator augmented elastic intramedullary nail at our institution from August 2015 to January 2019. RESULTS: All patients achieved bony union. We analysed patient's results both clinically and radiologically. On average, the surgery took 77.34 minutes to complete with an average time to union of 13.9 weeks. External fixator and elastic nail removal took an average of 3.59 months and 26.5 months, respectively. At the final follow-up, knee range of motion averaged 131.88 degrees. According to the Flynn criteria, functional outcomes were excellent in 18 patients, satisfactory in 11 patients and poor in 3 patients. Pin site infection occurred in 3 patients, malunion in 4 patients, limb length shortening < 1 cm in 3 patients, distal nail tip prominence and knee stiffness in 3 patients. CONCLUSION: The management of femur fractures in adolescents using an elastic nail augmented with an external fixator is a minimally invasive procedure that provide secure fracture stabilization and predictable outcomes.
RESUMO
Midtarsal dislocations of the foot are rare injuries. Most descriptions of these injuries state that they develop due to high-energy trauma. We present a case of low-energy trauma leading to a medial swivel dislocation of the talonavicular joint, which was reduced by a closed method and immobilized in a cast. A 48-year-old non-diabetic male with no rheumatoid symptoms or any steroid injection suffered low-energy trauma to his right foot and presented to the emergency department with pain, tenderness and with his foot adducted. On X-rays and NCCT, it was found to be medial type swivel dislocation of the Talonavicular joint with a fractured base of the fifth metatarsal and talar head impaction fracture with talocalcaneal joint subluxation. Closed reduction under sedation was done successfully, which was stable on stressing under fluoroscopy, so the foot was immobilized in a cast without internal fixation. Talonavicular dislocations are rare injuries, with most of them requiring open reduction and internal fixation. Low-energy trauma can also lead to talonavicular dislocations, which, if stable after reduction, can be immobilized in a cast without internal fixation.
RESUMO
BACKGROUND: Clubfoot constitutes roughly 70 percent of all foot deformities in arthrogryposis syndrome and 98% of those in classic arthrogryposis. Treatment of arthrogrypotic clubfoot is difficult and challenging due to a combination of factors like stiffness of ankle-foot complex, severe deformities and resistance to conventional treatment, frequent relapses and the challenge is further compounded by presence of associated hip and knee contractures. METHOD: A prospective clinical study was conducted using a sample of nineteen clubfeet in twelve arthrogrypotic children. During weekly visits Pirani and Dimeglio scores were assigned to each foot followed by manipulation and serial cast application according to the classical Ponseti technique. Mean initial Pirani score and Dimeglio score were 5.23 ± 0.5 and 15.79 ± 2.4 respectively. Mean Pirani and Dimeglio score at last follow up were 2.37 ± 1.9 and 8.26 ± 4.93 respectively. An average of 11.3 casts was required to achieve correction. Tendoachilles tenotomy was required in all 19 AMC clubfeet. RESULT: The primary outcome measure was to evaluate the role of Ponseti technique in management of arthrogrypotic clubfeet. The secondary outcome measure was to study the possible causes of relapses and complications with additional procedures required to manage clubfeet in AMC an initial correction was achieved in 13 out of 19 arthrogrypotic clubfeet (68.4%). Relapse occurred in 8 out of 19 clubfeet. Five of those relapsed feet were corrected by re-casting ± tenotomy. 52.6% of arthrogrypotic clubfeet were successfully treated by the Ponseti technique in our study. Three patients failed to respond to Ponseti technique required some form of soft tissue surgery. CONCLUSION: Based on our results, we recommend the Ponseti technique as the first line initial treatment for arthrogrypotic clubfeet. Although such feet require a higher number of plaster casts with a higher rate of tendo-achilles tenotomy but the eventual outcome is satisfactory. Although, relapses are higher than classical idiopathic clubfeet, most of them respond to re-manipulation and serial casting ± re-tenotomy.