CroniconO P E N A C C E S S EC ORTHOPAEDICS

Research Article

Neglected, Relapsed and Rigid CTEV (Club-Foot) Correction by G. A. Ilizarov Technique

Md Mofakhkharul Bari1*, Md Shahidul Islam2 and Md Mahfuzer Rahman3

1Chief Consultant, Bari-Ilizarov Orthopaedic Centre, Dhaka, Bangladesh2Bari-Ilizarov Orthopaedic Centre, Dhaka, Bangladesh3D. Ortho-Consultant, Bari-Ilizarov Orthopaedic Centre, Dhaka, Bangladesh

Citation: Md Mofakhkharul Bari., et al. “Neglected, Relapsed and Rigid CTEV (Club-Foot) Correction by G. A. Ilizarov Technique”. EC Orthopaedics 10.5 (2019): 322-325.

*Corresponding Author: Md Mofakhkharul Bari, Chief Consultant, Bari-Ilizarov Orthopaedic Centre, Dhaka, Bangladesh.

Received: March 28, 2019; Published: April 30, 2019

The Ilizarov circular external apparatus was originally designed in early 1950s [1,2]. The main parts are the standard elements used: wires, rings, wire fixation holes and buckles, while the secondary parts are the elements necessary for the assembling of the apparatus: threaded rods, telescopic rods, washers, bolts and nuts. The wires that are placed in different planes and are secured to modular rings under tension. These wires act as small springs within or more rigid system of rings and concerning rods. In this way the system provides strong stability against angular, rotational and transitional displacement. In addition, the Ilizarov apparatus allows multi planar and multi directional correction of deformities. The diameter of the rings must be at least 3 cm larger than the limbs. If the diameter of a rings is too large than the stability of the frame will be affected. Apparatus should be checked every day. Clinical sings of peripheral blood circulation and neurologic deficiency should be check every day during correction. Loss of the tensions will lead to instability, which will increase the inflammatory process at the contact areas of the skin with the wires and will cause pain.

Materials and Methods

Between (1990 - 2018) i.e. for the last 28 years 84 children were treated due to club- foot. 70 were boys and 14 were girls. The children were admitted at the Hospital and Ilizarov apparatus was applied under general anaesthesia. Usually 3 to 4 rings were required depend-ing on the severity of the deformity. The follow-up period was 2 to 15 years [3-5].

Complications

Abstract

The management of club-foot is one of the most difficult problems that the orthopaedic surgeon confronts in his daily practice. The procedures traditionally that we are using are i) serial plastering ii) operative technique. These traditional methods of manage-ment of club-foot are often less than satisfactory. Recent studies showed that the Ilizarov technique is a more popular technique than surgical intervention. We are presenting our experience in the treatment of club-foot with the use of Ilizarov apparatus-external ring device over a period of 28 years (1990 - 2018), in a series of 84 children. 70 are boys and 14 girls. Ages ranged from 2 year to 12 years. The rings that we used measured in its internal diameter in mm (60, 80, 100, 110). Bilateral club-foots were 56 patients and 15 were unilateral. Among the complications 14 pin track infections were observe that responded positively to local care.

Keywords: Club-Foot; Ilizarov Technique

The apparatus and the technique

323

Citation: Md Mofakhkharul Bari., et al. “Neglected, Relapsed and Rigid CTEV (Club-Foot) Correction by G. A. Ilizarov Technique”. EC Orthopaedics 10.5 (2019): 322-325.

Neglected, Relapsed and Rigid CTEV (Club-Foot) Correction by G. A. Ilizarov Technique

During the treatment period we dealt with a number of complications which included like local oedema, local skin tightness and pin track infections. These complications were treated accordingly.

Results

The final outcome was very satisfactory. Correction was achieved between 3 and 12 months (average 5½ months). After removal of Ilizarov we suggested orthos braces for all the patients.

Figure 1: During treatment with Ilizarov apparatus.

Figure 2: Full correction is achieved with Ilizarov apparatus.

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Citation: Md Mofakhkharul Bari., et al. “Neglected, Relapsed and Rigid CTEV (Club-Foot) Correction by G. A. Ilizarov Technique”. EC Orthopaedics 10.5 (2019): 322-325.

Neglected, Relapsed and Rigid CTEV (Club-Foot) Correction by G. A. Ilizarov Technique

Figure 3: After full correction front view.

Figure 4: After full correction back view.

Discussion

We started correction of club-foot with Ilizarov apparatus on the 2nd day after the application. Congenital and acquired deformities can be corrected by gradual distraction. For correction of equinovarus adductus the acceptable rate is 1 to 3 degrees per day, divided by 3 to 4 times. In the group of neglected, relapsed rigid and treated but uncorrected cases, a variety of procedures have been performed to improve the appearance of the foot. It will be correct to say that these difficult cases were treated by a step-by-step attempt at converting the deformed foot into a plantigrade position making use of one or a variety of procedures mentioned in the 6 basic methods available for

325

Citation: Md Mofakhkharul Bari., et al. “Neglected, Relapsed and Rigid CTEV (Club-Foot) Correction by G. A. Ilizarov Technique”. EC Orthopaedics 10.5 (2019): 322-325.

Neglected, Relapsed and Rigid CTEV (Club-Foot) Correction by G. A. Ilizarov Technique

treatment of clubfoot deformity. Cases so treated did not obtain good results. Since 1990 with the advent of Ilizarov’s technique of slow and controlled coordinated distraction, the program of management of neglected, relapsed, rigid and poorly corrected foot has been changed [1-4]. The method is most successful between the age of 2 to 12 years. Ilizarov has hinges for correction of rotational deformi-ties [5]. The distraction technique is a valuable addition to the surgeons options for correction. Once full correction is achieved the child is placed in a plaster cast after removing the apparatus from the leg and the foot. As the child is freely ambulated, the period of cast ap-plication does not cause any serious harm. Correction of neglected cases by a combination of soft tissue release and complex planning of Ilizarov fixators gives good success in almost in all the cases. With Ilizarov expertise all cases of clubfoot at least up to the age of 12 year can be corrected easily and many of the relatively traumatizing operations like Dwyers calcaneal osteotomy are no longer needed [6-8].

Conclusions

The Ilizarov method is a non-invasive operative technique without blood loss [1-3]. The whole system is a very stable one and permits early mobilization of the joints. The management of club-foot deformity by this method have many advantages. Surgical intervention and serial plastering are not required. However, the several technical problems can arise if the details of the technique are not followed pre-cisely. The inexperienced surgeons usually fail to carry out the whole technique. For successful tissue genesis one must have follow the rules and processes of the technique [1-4].

Bibliography

1. GA Ilizarov. “Transosseous Osteosynthesis the critical and Clinical Aspects of the Regeneration and Growth of Tissue”. Springer-Verlag (1992): 583-634.

2. Dror Paley. “Principles of deformity correction”. Springer-Verlag (2002): 623-626.

3. MM Bari. “A color atlas of limb lengthening surgical reconstruction and deformity correction by Ilizarov technique”. (1st Edition) (2013): 229-239.

4. MM Bari. “Management of Pes Equinus, Equinocavus and CTEV Deformities by G. A. Ilizarov Technique” (2006): 185-219.

5. MM Bari. “Compression distraction apparatus in paediatric orthopaedics” (2017): 25-38.

6. Porter RW. “Congenital talipes equinovarus. I – resolving and resistant deformities”. Journal of Bone and Joint Surgery 69B.5 (1987): 822-825.

7. Cummings J and Lovell WW. “Current concepts: Operative treatment of congenital idiopathic clubfoot”. Journal of Bone and Joint Sur-gery 70A.7 (1988): 1108-1112.

8. Dillwyn-Evans D. “Relapsed clubfoot”. The Bone and Joint Journal 43B.4 (1961): 722.

Volume 10 Issue 5 May 2019©All rights reserved by Md Mofakhkharul Bari., et al.