Magnetic resonance imaging of severe idiopathic club foot treated with one-week accelerated Ponseti (OWAP) technique.

PURPOSE: This study aims to evaluate changes in tarsal bones relationship after the use of one week accelerated Ponseti method in the treatment of severe idiopathic clubfoot using MRI. We hypothesize that one-week accelerated Ponseti is at least as effective as standard techniques in achieving the desirable MRI parameters. METHODS: This is a prospective study of 8 children with severe idiopathic clubfeet (Pirani 6) (4 unilateral and 4 bilateral) treated before the age of three months with one-week accelerated Ponseti technique, as described in a former study with minimum 2-year follow-up. The 8 corrected feet were compared with the 4 unilateral normal feet at clinical and radiological levels using a Pirani scoring system and an MRI, respectively. RESULTS: Clinical results showed that Pirani score was 1.1 in the last follow up in comparison to Pirani 6 pretreatment (p < 0.05). MRI results indicated that the malleocalcaneal angle, axial malleocalcaneal index, coronal tibiocalcaneal angle, sagittal talocalcaneal angle, and talar head neck calcaneal rotation showed statistical difference between the two groups (p < 0.05). Sagittal malleocalcaneal index, sagittal tibiocalcaneal angle, talar head neck rotation related to talar body, and posterior calcaneal rotation showed no statistical difference between normal feet and clubfeet after correction (p value >0.05). CONCLUSION: One-week accelerated Ponseti technique showed to be as effective and safe as other treatment methods through clinical and MRI follow up data. MRI role was to confirm the efficiency of this innovative accelerated technique, but not used as a routine follow up.

Alternating Biplanar Fluoroscopy in Percutaneous Nephrostomy to Approach Stones in Patients With Horseshoe Kidney: An Institutional Experience.

This case series aims to evaluate the use of alternating perpendicular biplanar fluoroscopy in percutaneous nephrostomies/percutaneous nephrolithotripsies (PCNs/PCNLs) to approach renal stones in patients with horseshoe kidneys. Between January 2012 and December 2019, PCNs/PCNLs were done for six patients with horseshoe kidneys having renal stones. Skin and renal calyceal entry points were determined by alternating perpendicular biplanar fluoroscopy using a portable C-arm machine in the conventional fluoroscopy unit. The site of renal access, postoperative complications, and residual stones was assessed. The mean age of the patients was 36.8 years. The mean stone size was 6.1 cm (2.1-16.05cm). In five out of six (5/6; 83%) patients, there was one access site. Four patients had their access site through the upper calyx, and one patient had it through the lower calyx. The stone-free rate was four out of six (4/6; 66.6%). One patient had a mild drop in hemoglobin postoperatively. There were no major complications reported. The implementation of alternating biplanar fluoroscopy was found safe and helpful in providing a better appreciation of renal anatomy and stone location in patients with horseshoe kidneys. This technique helps in approaching horseshoe kidney stones in PCN/PCNL without moving the patient or fluoroscopy machine, with a potential decrease in operation time and radiation exposure.