[Posterior release in congenital talipes equinovarus adductus]. / Liberación posterior del pie equinovaro aducto congénito (PEVAC).

OBJECTIVE: To show the utility of posterior release to correct adduct congenital talipes equinovarus (CTE) and describe the surgical technique. MATERIAL AND METHODS: This clinical trial was conducted from February 2002 to November 2008. Patients ages 0-24 months old with a diagnosis of adduct CTE were enrolled. Surgical treatment consisted of a posterior approach to the foot with Z-plasty of the tibialis posterior, flexor digitorum longus and flexor hallucis longus, capsulotomy, adductor hallucis release, and cast immobilization for 8 weeks. ANALYSIS: The sampling was non-randomized, non-probabilistic; patients were enrolled based on the diagnosis. The statistical analysis included the central trend and scatter measures, the Student "t" test, RR, and homogeneity chi square test. RESULTS: Twenty-five patients were enrolled, 13 females and 12 males, with a total of 30 feet, 10 left and 6 right, and 7 bilateral patients. Median age was 15 years (range 11-24 years). Correction was achieved and maintained in 27 feet. Three cases had adduct relapse and were managed conservatively. The statistical analysis showed the effectiveness of treatment. The result of the Student "t" test and the chi square test was p < 0.0002. DISCUSSION: The proposed treatment was effective to correct the adduct CTE, with a proven effectiveness of more than 90% in the patients included in this study. The age of onset of treatment > 18 months was a risk factor for residual adduct with a RR = 3.7.

[The Ludloff-Ferguson approach for congenital hip dislocation in children ages 2-4 years]. / Vía de Ludloff-Ferguson para luxación congénita de caderas en niños de 2 a 4 años.

OBJECTIVE: The objective of this study is to show that the Ludloff-Ferguson approach is feasible in patients aged 2-4 years and as an outpatient procedure. MATERIAL AND METHODS: Prospective, longitudinal, clinical-trial type of study, conducted from January 2008 to December 2009. Patients aged 2-4 years with a diagnosis of congenital hip dislocation were included. All of them underwent open reduction using the Ludloff-Ferguson approach as an outpatient procedure and they wore a Callot type of cast for 6 weeks. Bilateral hips were treated in a single stage. The study variables included the age, sex, operative time, bleeding, anesthetic time, infections and avascular necrosis of the femoral head. A nonrandomized, non-probabilistic sampling was performed; the statistical analysis included the central trend and scatter measurements, the relative risk, the Spearman correlation and chi2. RESULTS: Fifteen patients were included, 8 females and 7 males, for a total of 21 hips. The latter included 4 left and 3 right hips, and 7 cases were bilateral. Median age was 3 years (range 2-4 years). The mean bleeding was 20 cc with a SD of 5 cc (range: 15-30 cc). The mean operative time was 25 minutes, SD = 7 minutes (range: 17-30 minutes). The chi2 test rejected the Ho for sex and necrosis, and age and avascular necrosis, with a P = 0.005. The results of the Spearman test for sex and necrosis were r = 0.23, P = 0.002, for age and necrosis r = 0.25, and a P = 0.003, for the operative time and avascular hip necrosis r = 0.28, P = 001. There were no infections. DISCUSSION: The open reduction technique with the Ludloff-Ferguson approach is feasible in patients aged 2-4 years as an outpatient procedure, and the risk of avascular necrosis was minimum.