Objective Hyperextension of the big toe is described here as a simple and reliable sign to predict undercorrection of cavus deformity of clubfoot in the Ponseti Method. Materials & Methods This retrospective study was conducted on children with clubfoot who were treated successfully by Ponseti Method in the King Fahad Hospital, Saudi Arabia, and Emam Reza Hospital, Mashad, Iran, from 2003 through 2008. The total number of the patients in our study was 191, with 306 affected feet. Of them, 115 children had bilateral clubfeet (230 feet) and 76 had unilateral clubfoot. There were 119 males and 72 females. Hyperextension of the big toe at MTPJ was present in five cases of clubfoot. The average follow-up period was 20 months (range: 8-38 months). Results The authors observed that hyperextension of big toe at MTPJ had a linear relationship with the severity of cavus deformity of clubfoot. On the other hand, the big toe had a normal relationship with other toes after satisfactory treatment of the initial or relapsed cavus deformity by Ponseti Method. Conclusion Hyperextension of the big toe at MTPJ can be regarded as a reliable prognostic sign for detecting the severity, correction, and the number of castings needed for cavus deformity correction in clubfoot treatment in the Ponseti Method.
Предпосылки: Правильное проведение кортикотомии очень существенно при удлинении конечностей и коррекции деформации методом дистракционного остеогенеза. В настоящее время используются разнообразные методики кортикотомии/ остеотомии, но они не внушают достаточной уверенности относительно сохранения эндостального кровообращения и избежания повреждения надкостницы. В этой статье мы представляем новый простой и эффективный метод кортикото мии. Методы: Это исследование проводилось в Медицинском Университете Мешхеда (Иран) в период с июня 1995 года по сентябрь 2009 года. У 22 пациентов (24 конечности), являвшихся кандидатами на проведение удлинения конечностей с коррекцией деформации или без нее, одновременная кортикотомия проводилась новым методом, который мы наглядно представляем в этой статье. Результаты: Случаев преждевременной консолидации не было. В 19 конечностях рентгенологическое образование мозоли отмечалось в конце третьей недели, у всех наших пациентов — в конце четвертой недели. Оценки функции у пациентов и оценки удовлетворенности были лучше при посттравматических укорочениях и деформациях конечности по сравнению с врожденными нарушениями. Заключение: Кортикотомия при применении нового метода является простой в исполнении, более уверенной и предсказуемой, способной предупредить нежелательные повреждения кости и сохранить как периост, так и эндост. Ключевые слова: кортикотомия, остеотомия, надкостница (периост), эндост, Илизаров. Background: correct corticotomy is essential in limb lengthening and deformity correction by distraction osteogenesis. Currently a variety of corticotomy /osteotomy techniques are used but do not make enough confidence about preserving endosteal circulation and avoidance of periosteal damage. We introduce a new simple and efficient corticotomy method in this paper. Methods: This study was undertaken in Mashhad Medical University-Iran from June 1995 till September 2009. In 22 patients (24 limbs) who was candidate for limb lengthening with or without correction of deformity, simultaneous corticotomy was performed by a new method which we explain it descriptively in this paper. Results: There was not any premature consolidation. 19 limbs had radiologic callus formation at the end of 3 rd week and in all of our patients at the End of 4 th week. Patient functional scores and analogue satisfaction scores were better in post traumatic limb shortening and deformities in comparison to congenital disorders. Conclusion: Corticotomy with this new method is a simple, more confident and predictable one which can prevent undesirable bone cracks and preserve both periosteum and endosteum.
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