A comparative analysis of the two most common surgical exposures for clubfoot

Swagat Mahapatra; Vineet Thomas Abraham

doi:10.18203/2349-2902.isj20162026

Authors

Swagat Mahapatra Department of Orthopaedics, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pondicherry
Vineet Thomas Abraham Department of Orthopaedics, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pondicherry

DOI:

https://doi.org/10.18203/2349-2902.isj20162026

Keywords:

Hemi-cincinnati, Turco, Clubfoot, Pirani

Abstract

Background:The surgical release of clubfoot should address all the pathological structures, including a complex soft tissue release of the hind foot and mid foot, possibly one of the most complicated procedures performed in orthopedic surgery. As in any surgical procedure involving multiple anatomic steps, exposure is the key to a successful comprehensive release. This study was conducted with the aim of comparing two of the most widely used surgical exposures in clubfeet.

Methods: This was a prospective study of 35 patients having 60 diseased feet, aged between 1 to 3 years. Patients with neglected idiopathic clubfoot who did not respond to initial Ponseti’s casting; and were planned for Posteromedial soft tissue release (PMSTR) surgery were included in this study. Group I (18 patients-30 feet) underwent surgery using the hemi-cincinnati incision and group II (17 patients-30 feet) by turco method of exposure. 2 patients (3 feet) of the turco group were lost to follow-up. Preoperative and postoperative pirani scores were calculated and compared. Other clinical follow-up parameters included pain (were assessed using FLACC behavioral pain assessment scale) and wound complications (necrosis, adhesions and scar hypertrophy). Radiological parameters were also assessed.

Results:As per the difference between pre and postoperative (3 months) pirani score, 5 feet had a good result, 22 had satisfactory, and 3 had poor results in group I while in group II, 3 had good, 19 had satisfactory, and 5 had poor results. 2 feet in group I and 10 feet in group II had wound necrosis in the immediate postoperative period. There was no substantial difference in the postoperative angles in both groups.

Conclusions:PMSTR is an acceptable surgical method for treating neglected idiopathic clubfeet. The hemi cincinnati incision has lesser number of wound complications and also better deformity correction as evaluated by pirani scores. This study supports the use of hemi cincinnati incision over turco incision in posteromedial soft tissue release for treating idiopathic clubfoot.