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A mini-open technique for Achilles tenotomy in infants with clubfoot
Rhett MacNeille1, William Hennrikus2, Brian Stapinski3
1Department of Orthopaedics, Penn State Milton S. Hershey Medical Center, 30 Hope Drive, Entrance B, Suite 2200, Hershey, PA, 17033, USA. rmacneille@hmc.psu.edu.
Insights
A mini-open tendoachilles lengthening (TAL) in the operating room is a safe and effective procedure for infants with clubfeet. This technique minimizes risks of neurovascular injury and incomplete release, allowing same-day discharge.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Clubfoot treatment
Background:
- Tendoachilles lengthening (TAL) is crucial in Ponseti technique for clubfoot, often done percutaneously.
- Percutaneous TAL carries risks like bleeding, nerve injury, and incomplete release.
- The study evaluates a mini-open TAL approach in the operating room.
Purpose of the Study:
- To report the outcomes and complications of mini-open TAL performed in the operating room.
- To assess the safety and efficacy of this surgical approach in infants.
- To compare it with percutaneous methods.
Main Methods:
- Retrospective review of infants with idiopathic clubfoot undergoing mini-open TAL.
- Data collected from 2008 to 2015.
- Analysis of complications, discharge status, and need for repeat procedures.
Main Results:
- 63 mini-open TALs performed on 41 infants in day surgery.
- No anesthesia-related or neurovascular complications reported.
- No repeat TALs needed due to incomplete tenotomy; all patients discharged same day.
Conclusions:
- Mini-open TAL in the OR is safe and effective for infant clubfeet.
- Direct visualization reduces risks of neurovascular injury and incomplete tenotomy.
- Same-day discharge is feasible with this technique.
Purpose:
A tendoachilles lengthening (TAL) is indicated in over 85 % of cases treated with the Ponseti technique. A percutaneous TAL is often performed in the clinic. Reported complications from a TAL performed in the clinic include: bleeding due to injury to the peroneal artery, posterior tibial artery, or lesser saphenous vein; injury to the tibial or sural nerves; and incomplete release. The purpose of the present study is to report the results and complications of a mini-open TAL performed in the operating room (OR).
Methods:
The current study is a retrospective review performed among infants with idiopathic clubfoot who underwent a mini-open TAL from 2008 to 2015.
Results:
Forty-one patients underwent 63 TALs via a mini-open technique in day surgery. The average Pirani score was 5.8 prior to casting. The average number of casts applied prior to surgery was 5.2. The average age at the time of the TAL was 12.5 weeks (range 5-48 weeks). The average weight at the time of surgery was 7.3 kg (range 3.6-13 kg). No child had a delay in discharge or stayed overnight in the hospital. No anesthesia-related complications or neurovascular injuries occurred. No child needed a repeat TAL due to an incomplete tenotomy.
Conclusions:
In conclusion, mini-open TAL performed in the OR is safe and effective in infants with clubfeet. No complications occurred and all patients were discharged on the day of surgery. Direct visualization of the Achilles tendon via a mini-open technique minimizes the risk of neurovascular injury and incomplete tenotomy.
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