Parent reported outcomes for idiopathic clubfoot children treated with the Ponseti technique: An analysis of 140 feet followed minimum 5 years.

Objective: The treated clubfoot children are often evaluated clinically during follow-up. However, patient reported outcomes (PROM) are seldom analysed for these children. We investigated 87 idiopathic clubfoot children (140 feet) treated by the Ponseti method and followed minimum 5 years to study their clinical outcomes and PROM. Material and methods: This was a cross-sectional study, based on evaluating treated clubfoot children clinically (Pirani score) and PROM (Oxford Ankle and Foot Questionnaire - Parent Version) and comparing them with the age-matched healthy controls (n = 60). The questionnaire has four main domains related to the child's physical, school and play, emotional and footwear profile. The children having persistent deformity (residual/relapse) were specifically studied for their PROM scores. Results: The mean child age at initial treatment was 2.3 months and the mean follow-up duration was 6.9 years. The PROM score of clubfoot children was statistically lower than the healthy controls (p < 0.001). Of the individual domains, the physical domain was the most affected. On calculating the Pirani scores, 10 out of 140 feet (7 %) had some form of persistent deformity. The children with persistent deformity had lower Oxford scores than healthy children or those with corrected feet. The physical domain followed by the emotional domain scored low when persistent deformity was present. Conclusions: Most children (98 %) had a plantigrade foot following Ponseti treatment at follow-up. However, PROM score of the clubfoot children did not correspond to the clinical outcome. Persistent deformity, even minor, was a cause of parental concern and resulted in a low PROM score.

Effect of non-vascularized fibular harvest on the donor limb: radiological evaluation at a mean follow-up of twelve point eight years.

PURPOSE: The study is aimed at evaluating the long-term (at a minimum follow-up of 10 years) impact of non-vascularized fibular harvest on the donor limbs. METHODS: There were 27 donor limbs (n = 19 children) available for retrospective radiological review. The graft was obtained bilaterally in eight patients. The following parameters were evaluated in the follow-up radiographs: continuity/non-continuity of fibular regenerate, width of the regenerated fibula, distal fibular station, medial proximal tibial angle, posterior proximal tibial angle, lateral distal tibial angle (LDTA), anterior distal tibial angle, and tibia diaphyseal angulation (interphyseal angles). For analysis and comparisons, the donor limbs were compared to the healthy limbs (controls) of the children with unilateral harvest. Additionally, the impact of continuous and non-continuous fibular regeneration was separately analyzed. RESULTS: The mean child's age at the time of fibular harvest was four years. The mean follow-up was 12.8 years. The fibula was found regenerated in continuity in 22 limbs of 15 children (81.5%). When analyzed as a combined group (both continuous and non-continuous fibular regenerations), all the donor limb radiological parameters matched those of healthy limbs except LDTA (p = 0.04). In the subgroup analysis between non-continuous and continuous fibulae, significant abnormalities were again obvious in LDTA (p = 0.0001). The non-continuous fibulae were significantly lesser in width. All limbs with non-continuous fibular regeneration manifested ankle valgus. CONCLUSIONS: The non-vascularized fibula emerged as a relatively safe procedure in the long term with minimal affections of the knee, ankle, or tibial anatomy when longitudinal integrity of fibula was restored. The non-regenerations of the fibula may be prone to developing ankle valgus.

Hemiepiphysiodesis using tension band plates: does the insertion technique or screw length influence the rate of correction?

We retrospectively studied the effect of certain characteristics of the insertion technique and the construct of tension band plates on its angular correction rates. The study included 68 physes in 28 children. The following preoperative radiological parameters were measured: interscrew angle; the length of the epiphyseal screw, its distance and angle (screw trajectory angle) with respect to the physis. Additionally, changes in the mechanical lateral distal femoral angle and medial proximal tibial angle were calculated from the follow-up radiographs. The statistical calculations involved correlating the above-mentioned parameters and correction rates using a correlation coefficient. The mean patient age at the time of surgery was 8.6 years and the follow-up was 12.1 months. The mean screw trajectory angle was 13.4 degrees, the interscrew angle 18.9 degrees and the proportion of screw length was 41.3%. The mean correction rate recorded was 1.1 degrees/ month. The child's age (R = -0.13), screw trajectory angle (R = -0.13), interscrew angle (R = -0.02), distance of screw from physis (R = 0.04), and length of screw (R = 0.07) did not show statistically significant correlation with the angular correction rates. The correction rate produced by the tension band plate was found nearly independent of the parameters recorded for insertion technique (screw trajectory angle, interscrew angle, distance of screw from the physis) or construct (length of the epiphyseal screw). It functions as long as the physis is tethered by a side plate adequately secured by appropriate length screws.