Long-term outcome of extraarticular subtalar arthrodesis in children with cerebral palsy using modified Grice technique.

The purpose of the study is to describe and analyse long-term results of the modified Grice procedure with specially prepared pre-shaped autograft from iliac crest. 54 patients (101 feet) who underwent modified Grice procedure, were retrospectively analysed. Before and after the surgery, talocalcaneal (TC) angle and calcaneal inclination (CI) angle were measured and compared with post-operative values. Furthermore, AOFAS score was assess pre-and postoperatively as well as the subjective evaluation of the patients or their parents. Detailed analysis was performed separately for patients with different forms of CP. Postoperatively, TC angle and subjective assessment decreased, and CI angle and AOFAS score increased significantly compared to pre-operative values. The significant difference was observed among different CP groups in all observed parameters. Severe complications were not observed. The modified Grice procedure with specially prepared pre-shaped autograft showed promising long-term results.

ARE SCORING SYSTEMS USEFUL FOR PREDICTING RESULTS OF TREATMENT FOR CLUBFOOT USING THE PONSETI METHOD?

OBJECTIVE: The aim of this study was to verify whether the Pirani and Dimeglio clinical scoring systems could predict results of Ponseti therapy. METHODS: Forty-seven patients with clubfoot deformities treated with the Ponseti method were enrolled in the study. Clinical evaluation with the Pirani and Dimeglio scoring systems was performed before the treatment and after the second cast fixation. The number of fixations, necessity for achillotomy, and recurrence of the deformity were determined as parameters of the therapy results. The patients were divided into three groups according to the severity of their deformities, and the groups were compared with one another. RESULTS: Clubfoot correction required an average of 6.8 casts. Five patients developed a recurrence. Comparing the therapy outcomes among the groups, we found statistically significant differences in the Pirani classification after the second fixation (the number of casts [p =.003] and necessity to perform an achillotomy [p =.014]) and in the Dimeglio scores before therapy (number of casts [p =.034]) and after the second fixation (number of relapses [p =.032]). CONCLUSION: Although clinical scoring systems showed some dependence on the parameters of treatment outcomes, their predictive function can be used in only a limited way. Level of evidence II, Prospective comparative study.

OBJETIVO: O objetivo deste estudo foi verificar se os sistemas de pontuação clínica de Pirani e Dimeglio poderiam servir para prever os resultados do tratamento com o método de Ponseti. MÉTODOS: Quarenta e sete pacientes com diagnóstico de pé torto equinovaro tratados pelo método de Ponseti foram incluídos no estudo. A avaliação clínica com os sistemas de pontuação de Pirani e Dimeglio foi realizada antes do tratamento e depois da segunda fixação de gesso. O número de fixações com gesso, a necessidade de realização de aquilotomia e a recorrência da deformidade foram determinadas como parâmetros dos resultados do tratamento. Os pacientes foram divididos em três grupos, de acordo com a gravidade das deformidades, e esses grupos foram comparados entre si. RESULTADOS: A correção do pé torto exigiu uma média de 6,8 gessos e cinco pacientes apresentaram recidiva. Ao comparar os resultados do tratamento entre os grupos, verificou-se diferença estatisticamente significante na classificação de Pirani após a segunda fixação (número de gessos [p = 0,003], necessidade de realizar aquilotomia [p = 0,014]) e pontuação de Dimeglio antes do tratamento (número de gessos [p = 0,034]) e depois da segunda fixação (número de recidivas [p = 0,032]). CONCLUSÃO: Embora os sistemas de pontuação clínica tenham mostrado alguma dependência dos parâmetros dos resultados do tratamento, sua função preditiva pode ser usada de maneira limitada. Nível de evidência II, Estudo comparativo prospectivo.

The ultrasonography evaluation of talar dysplasia as a potential prognostic factor for predicting the course and outcomes of clubfoot deformity treatment using Ponseti technique.

OBJECTIVE: The aim of this study was to assess the role of sonographic evaluation of Talar dysplasia in predicting the outcome of standard Ponseti method in the treatment of clubfoot deformity. METHODS: A total 23 children (15 boys and 8 girls; mean age: 18.2 ± 5.4 days (8-32)) who underwent Ponseti treatment were included in the study. Before the treatment, maximal talus length of affected and non-affected feet were measured by US and relative talar dysplasia ratio (RTDR) was calculated. The patients were categorized 2 groups according to RTDR: group A - mild and group B - severe deformity. Pirani score was used for clinical evaluation. The groups were compared in terms of number of the applied casts, need of percutaneous tenotomy of Achilles tendon (AchT) and frequency of deformity recurrence. RESULTS: Pirani score was 4.46 for population (4.33 for group A; 4.54 for group B). Number of casts significantly differed between groups (p < 0.001) and positive correlation was found (r = 0.851, p < 0.001). AchT was performed in 56% cases for group A and in 86% cases for group B; no statistically significant difference was obtained (p = 0.162). Recurrence occurred in 2 patients belonging to group B without significant difference compared to group A (p = 0.502). CONCLUSION: Talar dysplasia assessment appeared as a promising prognostic factor for predicting the outcome of the Ponseti technique in treatment of clubfoot deformity. LEVEL OF EVIDENCE: Level IV, diagnostic study.

Use of locking compression plates for deformity correction of the forearm bones in children.

THE AIM OF THE STUDY: The aim of our study was to assess treatment results of angular deformities in distal radius by a system of the locking compression plates (LCP) at our clinic. METHODS: Our source data was collected prospectively from the records of patients where the locking compression plate was used for angulation correction of distal forearm between 2006 and 2007. The patients were divided by sex, the age range was defined and two groups were formed based on the initial diagnosis: the group of posttraumatic deformities (2 patients; 29 %) and the group of no traumatic deformities (3 patients with congenital shortening of ulna, valgus deformity and overgrowth of radius and 2 patients with exostoses multiplices with shortening of ulna and overgrowth of radius with ulnar angulation). The following parameters were set: radial articular angle and carpal slip prior to and after angulation correction, the healing period, the range of movement of the surrounding joints and occurrence of complications. RESULTS: We recorded only one case of delayed healing which was subsequently sustained by autospongioplastics and adjusted to normal. In the rest of the cases deformity correction occurred and the defined parameters were then corrected to normal. We observed no postoperative complications or permanent consequences. CONCLUSIONS: A two-year follow-up period monitoring treatment and therapeutic results of deformities in the forearm bones at our clinic, confirmed a minimal incidence of complications and a high percentage of successfully treated cases.

Evaluation of bone healing in femurs lengthened via the gradual distraction method.

BACKGROUND: Treatment of leg length inequality via lengthening of the shorter extremity is an infrequent orthopedic procedure due to the requirement of special distraction devices and possible serious complications. Essential qualitative changes in operative technique development are associated with the name of G. A. Ilizarov, who paved the way for the autoregenerate gradual distraction method in the 1950s. MATERIAL AND METHODS: In the years 1990 through 2006 a total of 57 patients underwent femur lengthening via gradual distraction using various types of external fixators at the Department of Pediatric Surgery, Orthopedics, and Traumatology, Faculty Hospital in Brno. The quality of bone healing was monitored and a number of parameters followed and statistically evaluated using regularly scheduled X-ray examinations. RESULTS: In 11 cases we had to remove the external fixator following the distraction phase, perform an osteosynthesis via a splint and fill the distraction gap via spongioplasty. The bone healing was satisfactory in the remaining 46 patients and the lengthened bone required no other fixation method. The analysis showed statistically significant deceleration in bone healing following distraction in female patients over 12 years of age, and in boys over 14 years of age. Lack of periosteal callus five weeks after surgery always signified serious problems in further healing. Severe complications were recorded in 11 cases during the distraction phase, and in 9 cases after the removal of the distraction apparatus. CONCLUSIONS: The aim of this report was to present the results of our study of distraction gap bone healing using the gradual lengthening approach.