Long term follow-up of surgrically treated skeletal deformities in osteogenesis imperfecta

In this study we evaluate the long term functional results in surgically treated Osteogenesis Imperfecta [O.I.] patients. The goals of our treatment are to maximize function, minimize deformity and disability. We reviewed 128 patients with O.I. who presented to the out patients Orthopaedic Department of the Paediatric Hospital, Cairo University. In this study we present the functional results in 31 surgically treated patients who responded to our letters among 62 operated children scince 1984. Most of the children were operated upon at a delayed age [average 6.5 years]. Our follow-up period range from 4 to 14 years [average 7 years]. None of these patients attended their follow-up dates on a regular basis, and our policy was to review them every 6 months. Revision surgeries were done for a large mumber of patients [71%]. Complications following surgery were common. At the final examination, there were only 4 patients walking without aid

Evaluation of the results of surgical treatment of idiopathic clubfeet

Since Turco [1971] has started the one stage posteromedial release with internal fixation, many surgeons have other approaches for surgical treatment of clubfeet with internal fixation. Norris Carroll [1987] described curvilinear medial and posterolateral incisions through which all components of the foot deformity are corrected including the release of the calcaneocuboid joint. The goals of this study are to evaluate the results of surgical treatment of idiopathic clubfeet with a minimum period of 2 years follow-up using the Norris Carroll technique, to figure out the best way to achieve a long lasting correction and to analyse the possible causes of unsatisfactory results. This work was carried out in the Paediatric Orthopaedic Unit of the Children Cairo University Hospital. 46 patients [34 boys and 12 girls] presenting with 66 idiopathic clubfeet were selected from 300 surgically corrected clubfeet using the same technique since 1988. All patients presenting with neuromuscular disease, arthrogryposis and specific syndromes were excluded as well as the patients with incomplete files or not having a period of minimum 2 years follow up. The patients age at surgery averaged 17 months [range from 6 to 46 months]. Pre-operative radiographs were taken for assessment of the clubfoot angles [talo-calcaneal angles, talo-first metatarsal angle] and calcaneocuboid relationship. The Norris Carroll technique had been used in all feet. On the first post-operative day radiographs were taken to evaluate the surgical correction. A crepe bandage was applied to all feet during the first post-operative week, then an above knee plaster of Paris was applied for about 12 weeks; the kirshner wire was removed at an average 4 weeks post-operatively. The average length of follow up was 62 months [range 24-108 months], during which 33 patients used on regular basis on ankle fast orthosis to maintain the foot in a corrected position. All patients had final clinical and radiological assessment of the degree of foot correction. Clinically, 33 feet were fully corrected, 13 overcorrected and 20 feet were uncorrected. Among the later 20, 5 feet had revision surgery. We conclude that idiopathic club foot is a complex deformity, long lasting correction is possible for surgically treated feet, provided a proper surgical technique is used and a close regular follow up is continued with the child is walking ad there is clinical and radiological evidence that the foot is remaining plant grade