Comparison of Long Term Results of Two Surgical Techniques In Pes Equinovarus Treatment

Year 2013, Volume: 15 Issue: 3, 1 - 4, 01.12.2013

Murat Erdoğan Orhan Karsan Mesut Kılıç

Abstract

Objective: Surgical treatment of pes equinovarus (PEV) is sometimes a necessity for patientsthat do not respond to conservative treatment. This study aimed to compare the long termfunctional and radiographic results of Posteriomedial release (PMR) and Complete subtalarrelease (CSTR) techniques.Materials and Methods: We evaluated 84 feet of 59 (45 boy and 14 girls) patients whounderwent surgical treatment ( Posteromedial release and subtalar release) for PEV. The meanfollow-up period was 94.7 months ( 7.83 years). The functionel assessment was made accordingtoLaaveg-Ponseti functional scoring system and the radiographic evaluation was made by usingthe anteroposterior talocalocaneal angle , lateral talocalocaneal angle and talus-first metatarsalangle. Bimalleolar angles were measured.Turco incision was used for both techniques. PearsonChi Square was used for statistical analysis. This study was made by the B.30,2ATA.0.01.00/87numbered permission of ethical committee of Atatürk University.Results: Functional results were excellent in 62.6% of feet, good in 2.3% of feet, fair in 22.3%of feet, and poor in 2.8% of feet that underwent CSTR. Functional results were excellent in44.8% of feet, good in 33.8% of feet and fair in 21.4% of feet that underwent PMR. None ofthe patients were assessed as poor that underwent PMR.There were statistical significantdifferences between the two surgical procedures with respect to functional scores andcomplications (p

Keywords

PEV, surgical treatment, long term results

Pes Equinovarus Tedavisindeki İki Cerrahi Tekniğinin Uzun Dönem Sonuçlarının Karşılaştırılması

Abstract

Amaç: Konservatif tedaviye cevap vermeyen hastalarda pes equinovarus (PEV) cerrahisialternatif bir tedavi yöntemidir. Bu çalışmamızda Posteriomedial gevşetme (PMR) ve Kompletsubtalar gevşetme (CSTR) tekniklerinin uzun dönem fonksiyonel ve radyolojik sonuçlarınınkarşılaştırılması amaçlanmıştır.Yöntem: Pes ekinovarus olgularında kliniğimizde yapılan cerrahi tedavi (Posteromedialgevşetme ve komplet subtalar gevşetme) sonuçlarının karşılaştırılması amacıyla 59 hastanın 84ayağı değerlendirildi. Hastaların 45’i erkek 14’ü kız çocuklarıydı.Takip süresi ortalama 94,7aydı(7.83 yıl).Postoperatif olarak hastaların fonksiyonel değerlendirilmeleri Laaveg-Ponsetifonksiyon değerlendirme skoruna gore yapıldı. Hastaların radyolojik değerlendirilmeleri iseanteroposterior ve yan talokalkaneal açılar, talus 1.metatars açısı ile yapıldı. Ayak bimalleolaraçıları ölçüldü.Her iki teknikteTurco insizyonu uygulanmıştır.İstatistik değerlendirmede PearsonKi karekullanılmıştır. Bu çalışma Atatürk Üniversitesi etik kurulunun B.30,2ATA.0.01.00/87sayılı izni ile yapılmıştır.Bulgular: CSTR yapılan ayakların % 62,6’sı mükemmel, % 2,3’ü iyi, %22,3’ü orta ve %2,8’ikötü olarak değerlendirildi. PMR yapılan ayakların %44,8’I mükemmel, %33,8’i iyi ve %21,4’üorta olarak değerlendirildi. PMR yapılan hiç bir hastada kötü sonuç alınmadı.Sonuç olarak CSTRve PMR teknikleri arasında fonksiyonel ve komplikasyon sıklığı yönünden İstatistiksel olarakanlamlı fark bulundu (p

Keywords

PEV, cerrahi tedavi, uzun dönem sonuçlar.

References

• Jürgen F. Our Experience With the Early Operative Treatment of CongenitalPEV J of Pediatric Orthopeadics1988;8: 26-30.
• McKay DW. New Concept of and Appraoch to PEV Treatment: SectionI Principlesand Morbid Anatomy J of Pediatric Orthopeadics1982;2: 347-356.
• Bombacı H. Comparison of posteromedial release and complete subtalar release of talipes ekinovarus, İstanbul, 1992
• Dravic DM. Congenital Club Foot Orthopedic Clinics of North America1989;20: 641-647
• Cummings RJ. An İnstructional Course Lecture, American Academy of OrthopaedicSurgeons Congenital PEV J Bone Joint surg2002;84-A: 290-308.
• Carroll NC. The Pathoanatomy of Congenital PEV Orthopedic Clinics of NorthAmerica1978;9: 225-232
• Ponseti İV. Current Concepts Review Treatment of Congenital PEV. J BoneJoint surg1992;74-A: 448-454.
• İppolito E. Long-term Comparative Results in Patients With Congenital PEV TreatedWith Two Different Protocols J Bone Joint surg 2003;85-A: 1286-1294.
• Kite JH. Nonoperative Treatment of Congenital PEV Clinical Orthopaedics andRelated Reserch1972;84: 29-38.
• Laaveg SJ. Long-Term Results of Treatment of CongenitalClub Foot J Bone Joint surg1980;62-A:23-31.
• Lampert WBS. Tachdjian's pediatric orthopaedics 3.edition. Tachdjian's pediatric orthopaedics 2002
• Yamamato H.One Stage Posteromediyal Release of Congenital PEV JofPediatric Orthopeadics 1988; 8: 590-595.
• Brougham Dİ. Use of Cincinnati Incision in Congenital Talipes Equinovarus J ofPediatric Orthopeadics 1988; 8: 633- 740.
• Turco VJS. Current management of PEV. Instr Course lect1982;31: 218-234.
• Okur A. Review of literature of talipes equinovarusand outcomes of our treatmentErzurum, 1991
• Halanski MA. Ponseti Method Compared with Surgical Treatment of PEV: A Prospective Comparison, J. Bone Joint Surg. Am., February 1, 2010; 92(2): 270 - 278.
• Bridgens J, Kiely N. Current management of PEV (congenital talipesequinovarus), BMJ, February 2, 2010; 340(feb02_1): c355 - c355.
• Gökmen D. Long-term results of extensive surgical dissection in the treatment of congenital PEV,ActaOrthopTraumatolTurc 2008;42(1):44-52.
• Dobbs MB. Long-Term Follow-up of Patients with Clubfeet Treated with Extensive Soft-Tissue Release, The Journal of Bone and Joint Surgery (American).2006;88:986-996.
• Kalenderer O. Correlation of clinical and radiologic results of complete subtalar release in congenital PEV, Acta Orthop Traumatol Turc 2003; 37(5):368-73
• Jain AK. Evaluation of Foot Bimalleolar Angle in the Manegment of Congenital Talipes Equinovarus J Pediatric Orthopeadics 2001; Vol 21 No 1: 55-59