The technique of the Ilizarov's principle on tension-stress combined with limited osteotomy of triple joint for correction of the severe adult talipes equinovarus / 中华骨科杂志

ABSTRACT

Objective To explore the application of the Ilizarov's principle on tension-stress in correction of adult severe talipes equinovarus. Methods From January 1996 to February 2003, 12 patients (13 feet) were corrected with this method, which involved 9 males and 3 females, whose average age was 26 years old (ranged from 20-36 years). The left foot was afflicted in 4 patients, and the right foot in 7, both side in 1. Among these patients, 3 were congenital, 6 were caused by the poliomyelitis, 1 by trauma, 1 by complication from encephalitic paralysis and 1 by radiotherapy for the cavernous hemangioma of the leg. The Ilizarov distraction apparatus of the ankle and foot joint were equipped in terms of the diseases preoperatively. During the operation, the release of the postero-medial soft tissue and the limited osteotomy of triple joints of the clubfoot were performed. According to the principles of Ilizarov, the wires were inserted and the fixator installed, the distraction devices of the ankle and foot joint which had corrective function in three-dimensional directions were applied to the tibia and foot, the telescopic rods on the apparatus were rotated one week after the operation. The deformity of talipes equinovarus, internal rotation and the drooping of the forefoot were gradually corrected, and the patients could bear weight and walked on the deformity foot during the course of distractive correction. Results All the 12 patients were available at follow-up with a mean duration of 15 months (ranged from 7 months to 4 years). There was no recurrence of the deformity and the feet function was good while walking on full weight-bearing. The mean duration of traction was 71 days. 10 patients (11 feet) could gain 0? in full weight-bearing, 2 patients preserved the drooping feet deformity at 15?-20? (because of shortness in the lower extremety). None of the complications occurred postoperatively, such as infection in the incision or pin tract, necrosis of the flap, neurovascular injury and nonunion. Conclusion Utilizing Ilizarov's principle on tension-stress to correct severe adult talipes equinovarus is a safe, minimally invasive and effective method.