THE USE OF EXTERNAl FIXATOR IN THE MANAGEMENT. OF RESISTANT AND RElAPSED CLUBFOOT

Abstract

Hippocrates (1927) was the first to advocate orthopaedic treatment of the idiopathic clubfoot by gentle manipulation and bandaging. -\_. According to Turco (1979) manipulative treatment leads to a 35% success rate, whereas surgery is the method of treatment in about 65% of idiopathic talipes equino varus feet (CTEV).

Regardless of early and adequate surgery, the failure rate remains as high as 20%. When facing complex congenital foot deformities, this rate of failure is even higher.

., In the relapsed clubfoot and neglected cases, the recommended treatment will include repeated soft tissue procedures, osteotomies, bony resection, or arthrodesis. Although, a satisfactory and permanent correction can be achieved, the salvage procedures correct only one deformity at a time. They are preferably performed at skeletal maturity and often produce a short stiff foot. By progressive soft tissue stretching, . the external fixator seems to avoid the above problems, allowing a simultaneous three dimentional correction at the same time without the need for bony resection or fusion.

Twenty patients of relapsed and neglected clubfoot treated by an assembled external fixator followed by serial corrective casting, above knee night splint, and medical boot. The average age at time of application of the fixator was 8.5 year, and the duration of follow up care varied from 9 to 30 months.