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Outcomes of Management of Severe Clubfoot among Children by Ilizarov External Fixator
M Nwet1, R Vignesh2, W Khaing3
1Surgical Based Department, Universiti Kuala Lumpur Royal College of Medicine Perak (UniKL RCMP), Ipoh, Malaysia.
Insights
The Ilizarov external fixator effectively treats severe clubfoot in children, achieving good to excellent outcomes with manageable complications. This minimally invasive method shows promise for complex foot deformities.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Biomedical Engineering
Background:
- Clubfoot is a common musculoskeletal birth defect requiring effective management.
- Various treatments exist, but minimally invasive Ilizarov external fixator shows potential for good outcomes and fewer complications.
Purpose of the Study:
- To analyze the morphological and functional outcomes of treating severe clubfoot using the Ilizarov external fixator in children.
- To evaluate the efficacy of this method for complex and neglected cases.
Main Methods:
- Study included 32 children (44 clubfeet) with Dieglio type III and IV severe clubfoot, including those with failed previous treatments.
- Ilizarov external fixator was used, followed by a short-leg walking cast and orthosis.
- Outcomes were assessed using the Laaveg and Ponseti functional rating system at 1 and 12 months.
Main Results:
- 86.4% of patients achieved good or excellent outcome scores.
- Statistically significant improvements were observed in pre- and post-treatment scores (p<0.001).
- Complications included pin site infections (29.54%), claw toes (11.36%), skin necrosis (6.81%), and calcaneal fractures (4.54%), all manageable.
Conclusions:
- The Ilizarov external fixator is effective in correcting severe clubfoot deformities with minimal morbidity.
- Larger, long-term studies are needed to assess adult outcomes, including hindfoot stiffness and degenerative changes.
Introduction:
Clubfoot remains the most common birth defect involving the musculoskeletal system. There are various surgical and non-surgical treatment options available for the management of clubfoot. Using the minimally invasive Ilizarov external fixator method has been reported to have good success rates and fewer complications.
Materials And Methods:
This study aimed at analysing the morphological and functional outcomes of treating severe clubfoot by Ilizarov external fixator among children from July 2017 to March 2020. Thirty-two children who had either failed Ponseti / surgery or neglected with 44 clubfeet of Dieglio type III and type IV were included in the study. A short-leg walking cast was applied for an additional six weeks after removing of Ilizarov frame and additionally followed by an orthosis for another six weeks. Outcomes were measured by the functional rating system by Laaveg and Ponseti and interpretation done at 1 month and 12 months after the ankle-foot arthrosis.
Results:
About 86.4% of the patients had good or excellent outcome scores. Pre and post-Demeglio scores and functional rating scores were statistically significant (p<0.001) by using Paired t-test. Complications included superficial pin site infections in 13 feet (29.54%), 5 feet (11.36%) had claw toes, 3 feet (6.81%) had linear skin necrosis and 2 feet (4.54%) had calcaneal fractures which were manageable with minor interventions.
Conclusion:
The study findings highlighted that the Ilizarov external fixator method can correct complex foot deformities of severe clubfoot with minimum morbidity. Further larger and long-term studies are needed to investigate the effects of the stiff hindfoot and possible degenerative changes on the function and symptoms of these patients as adults.
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