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[Subtalar stabilization of pes equinovalgus by conventional open surgery using bicortical iliac crest bone graft
1Klinika detské chirurgie, ortopedie a traumatologie FN, Brno.
Purpose Of The Study:
The aim of the study was to analyze the results of subtalar stabilization of the foot by conventional open surgery with the use of bicortical graft in cerebral palsy patients with pes equinovalgus and to compare our results with those of other authors.
Material:
A total of 193 operations were performed, with bilateral surgery in 84, surgery on the right foot in nine and surgery on the left foot in 16 patients. The average follow-up was 5 years and 2 months.
Methods:
Before and after surgery, the clinical presentation in each patient was evaluated according to our subjective, description- based classification using a I-to-III scale (I, normal foot; II, moderate deformity; III, severe deformity). On lateral radiographs of the foot in a standing position, the talocalcaneal (TC) angle and that between the longitudinal calcaneus axis and foot-supporting surface (CS) were measured. The data was analyzed by statistical methods.
Results:
The pre-operative findings were compared with the post-operative ones on the basis of our I-III classification system. In all results obtained with the McNemar test, p-values were lower than 0.001; therefore, at a 5 % level, the null hypothesis can be ruled out and a conclusion can be drawn that this surgery has an effect on the change in foot shape, as defined by our classification. Surgery failed in 13 feet (6.7 %), i.e., it did not produce any change in the degree of deformity. Similarly, values of the TC and CS angles were compared. The null hypothesis of Wilcoxon's test is that the patient's condition (TC and CP angles) remains the same before and after surgery. In all cases, the p-values were lower than 0.001; therefore, at a 5 % level, the null hypothesis can be ruled out, with the conclusion that differences between pre- and postoperative conditions were statistically significant.
Discussion:
The results of this study, as compared with the relevant data, show that, for correction of pes equinovalgus, subtalar stabilization with bicortical iliac crest graft is a sufficiently reliable method even without metal fixation. The failure rate is only 6.7 %.
Conclusions:
The method described here achieves good results, the validity of which is supported by statistical analysis. Key words: cerebral palsy, pes equinovalgus, subtalar extra-articular arthrodesis.