Multiple Serial Casting for Recurrent Clubfoot in Arthrogryposis Corrects Deformity With Diminishing Returns.

Purpose: Arthrogryposis multiplex congenita (AMC) consists of more than 400 conditions involving severe joint contractures of at least two or more body regions. Management of clubfoot in patients with AMC is notoriously challenging, with a higher likelihood of recurrence than idiopathic clubfoot, which can be treated using the Ponseti technique to avoid or delay more invasive procedures. The purpose of this study is to determine the utility of multiple serial casting as a treatment of clubfoot in AMC using Pirani scores as an objective measure of deformity.

Reorientational Proximal Femoral Osteotomies for Arthrogrypotic Hip Contractures.

Background: Severe hip contractures in arthrogrypsosis are multiplanar, which can preclude or can greatly complicate sitting and ambulation. The reorientational osteotomy at the intertrochanteric level preserves preoperative hip motion but moves it to a more functional domain. We retrospectively compared preoperative and postoperative hip motion and evaluated the ambulatory abilities of patients who underwent the procedure.

Distraction Osteogenesis of the Fibula to Correct Ankle Valgus in Multiple Hereditary Exostoses.

Gradual distal fibula lengthening (DFL), in conjunction with other procedures, was used to correct ankle valgus and short fibulae in three pediatric patients with multiple hereditary exostoses (MHE). The average amount of DFL was 15 mm with a mean follow-up of 2.9 years.

Design and descriptive data of the randomized Clubfoot Foot Abduction Brace Length of Treatment Study (FAB24).

The aim of this study was to describe the design and baseline characteristics of participants enrolled in the prospective randomized-controlled Clubfoot Foot Abduction Brace Length of Treatment Study (FAB24). Foot abduction bracing is currently the standard of care for preventing clubfoot relapse. Current recommendations include full-time bracing for the first 3 months and then 8-12 h a day for 4 years; however, the optimal length of bracing is not known.

Syndromic Feet: Arthrogryposis and Myelomeningocele.

Treatment of myelomeningocele and arthrogrypotic foot deformities has been controversial; many different procedures have been advocated for each type of deformity. In most cases, outcomes have had variable success rates, and many complications can occur. Treatment strategies should highlight care that avoids the development of a stiffened foot and allows for a variety of options to regain correction when a relapse occurs.

Summary of the 2nd International Symposium on Arthrogryposis, St. Petersburg, Russia, September 17-19, 2014.

Enormous progress has been made in understanding the etiology and therapies for arthrogryposis (multiple congenital contractures). A 2nd International Symposium on Arthrogryposis was sponsored by the Turner Institute in St. Petersburg, Russia.

Safety and Efficacy of Botulinum Toxin A in Children Undergoing Lower Limb Lengthening and Deformity Correction: Results of a Double-blind, Multicenter, Randomized Controlled Trial.

Background: Lengthening of the lower limb is a complex procedure in which pain management and complications such as pin-site infections and muscle contractures impact the family and affect the child's quality of life. As a result, the paralytic and antinociceptive actions of neurotoxins may be indicated in managing these complications; however, few studies have explored ways to improve outcomes after lengthenings. The objective of this study was to evaluate the safety and efficacy of botulinum toxin A (BTX-A) in children undergoing lower limb lengthenings and deformity correction.

The efficacy of rib-based distraction with VEPTR in the treatment of early-onset scoliosis in patients with arthrogryposis.

Background: Although arthrogryposis multiplex congenital (AMC) is a rare condition, rapidly progressive scoliosis is common in children with AMC. Only a limited number of studies characterize the nature of these curves, and even fewer describe surgical outcomes. To determine efficacy or rib-based distraction in these patients, we reviewed the outcomes of the use of the Vertical Expandable Prosthetic Titanium Rib (VEPTR) device in what we believe is the first study to report this.

Treatment of the neglected and relapsed clubfoot.

Treatment of the neglected and the relapsed clubfoot is one of the most controversial topics in pediatric foot care. This article reviews the breadth of treatment options for practicing podiatrists or orthopedists with a specialty in complex clubfoot treatment. Discussion includes the appropriate circumstances for the use of the different procedures presented and the author's preferred treatment algorithm, based on 15 years of treating neglected, relapsed, and nonidiopathic clubfeet.

Achievement of gross motor milestones in children with idiopathic clubfoot treated with the Ponseti method.

Background: The Ponseti method of idiopathic clubfoot treatment involves a series of weekly casts, a percutaneous Achilles tenotomy if needed, followed by wearing a foot abduction orthosis (FAO). Gross motor development of children with idiopathic clubfoot has not been examined. The purposes of this study were to determine the ages of achievement of gross motor milestones in children with clubfoot treated with Ponseti method and to compare those ages with historical normative developmental data.

Progression of idiopathic clubfoot correction using the Ponseti method.

The Ponseti technique involves sequential clubfoot correction by abduction, supination, and finally dorsiflexion. Although shown to be effective, correction progression has not been examined. The Dimeglio/Bensahel classification system was used to analyze heel equinus, varus, midfoot rotation, adduction, posterior crease, medial crease, and cavus initially and after each casting.

Pelvic positioning creates error in CT acetabular measurements.

Background: CT allows for accurate measurement of acetabular orientation and shape, but malpositioning of the pelvis may lead to measurement variance.

Purpose: We therefore sought to determine: (1) whether acetabular anteversion measurements using the femoral head centers differed from those using the posterior ischia, and (2) the extent to which changing obliquity, rotation, and tilt of a pelvis in a CT scanner affected the measurement of acetabular variables.

Methods: A radiopaque human pelvis model with articulated hips was suspended from a plastic sheet as part of an adjustable frame.

Ponseti treatment for clubfeet: an international perspective.

Purpose Of Review: The purpose of this article is to acquaint the reader with the Ponseti method of clubfoot treatment and to describe the features of the technique that make it superior to other forms of clubfoot treatment. These features make the technique applicable across a wide spectrum of healthcare delivery systems on a truly international basis.

Recent Findings: The Ponseti method has proven to be successful around the globe, in both industrialized countries and developing nations.

Clubfoot classification: correlation with Ponseti cast treatment.

Background: Many different clubfoot classification systems have been proposed, but no single one is universally accepted. Two frequently cited systems, developed by Dimeglio/Bensahel and Catterall/Pirani, are often used for evaluation purposes in the treatment of idiopathic clubfoot. Our hypothesis was that the initial scores would be positively correlated with the number of casts required for clubfoot correction, indicating to us that the more severe score would require more casts, and therefore truly show the accuracy and usefulness of the scoring system.

Articulated hip distraction: a treatment option for femoral head avascular necrosis in adolescence.

Purpose: To describe the clinical outcomes of adolescent patients treated with articulated hip distraction (AHD) for avascular necrosis (AVN) of the femoral head. Outcomes were examined in order to better understand the usefulness of and indications for performing hip arthrodiastasis in this patient population.

Methods: : Retrospective review was performed on 31 hips with femoral head AVN treated with AHD.

Correction of arthrogrypotic clubfoot with a modified Ponseti technique.

Surgical releases for arthrogrypotic clubfeet have high recurrence rates, require further surgery, and result in short, painful feet. We asked whether a modified Ponseti technique could achieve plantigrade, braceable feet. Ten patients (mean age, 16.

Conformational instability of the taylor spatial frame: a case report and biomechanical study.

Background: The Taylor spatial frame (TSF) is a second-generation circular fixator used for limb lengthening and deformity correction. While treating a patient for pseudoarthosis, gross instability of a particular TSF construct was observed. A subsequent mechanical study of the TSF was then performed to better understand how its configurations affect frame stability.

Treatment of knee flexion contractures in patients with arthrogryposis.

Background: Knee flexion contractures in children with arthrogryposis are difficult to treat. The purpose of this study was to assess the effectiveness of posterior knee releases and gradual contracture distraction with an Ilizarov external fixator in correcting and maintaining correction of knee flexion contractures of 40 degrees or greater.

Methods: The medical records and radiographs of 7 consecutive pediatric patients (10 knees) with arthrogryposis and knee flexion contractures of 40 degrees or greater were reviewed.

Treatment of acute salmonella epiphyseal osteomyelitis using computed tomography-guided drainage in a child without sickle cell disease.

Salmonella osteomyelitis occurs infrequently in children without sickle cell disease. Similarly, acute osteomyelitis of the epiphysis has been rarely reported. We present a case of primary epiphyseal osteomyelitis caused by Salmonella in the distal femur of an otherwise healthy 17-month-old child.

Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up.

One hundred and thirty-seven idiopathic clubfeet were treated by the Ponseti technique and followed for at least 2 years. Nine feet (7%) were not corrected with initial casting and required early surgery. Recurrence after correction was related to compliance with bracing.

Calculation of rotational deformity in pediatric supracondylar humerus fractures.

Objective: Supracondylar humerus fractures (SCHF) are common in the pediatric population. Cubitus varus deformity (CVD) is the most common long-term complication of SCHFs and may lead to elbow instability and deficits in throwing or extension. Distal fragment malrotation in the axial plane disposes to fragment tilt and CVD; however, no simple method of assessing fracture malrotation exists.

Interobserver and intraobserver reliability of radiographic evidence of bone healing at osteotomy sites.

Plain radiographs are commonly used to evaluate the degree of bone healing after an osteotomy and the application of an external fixator. The purpose of the study was to assess intraobserver and interobserver reliability in determining bone healing, defined as bridging callus across three of four cortices, of osteotomy sites on radiographs. Substantial intraobserver reliability and a high intraobserver percentage agreement were found.

Minimalistic approach to treating wrist torus fractures.

Thirty-three patients with unilateral wrist torus fractures were reviewed retrospectively. Patients were all treated with a removable plaster-of-Paris volar forearm splint and a symptom-based splinting protocol. This protocol emphasized the parents and patients deciding when to wean from the splint as their symptoms improved.

Use of the foot abduction orthosis following Ponseti casts: is it essential?

The purpose of this study was to evaluate the need for the use of a foot abduction orthosis (FAO) in the treatment of idiopathic clubfeet using the Ponseti technique. Forty-four idiopathic clubfeet were treated with casting using the Ponseti method followed by FAO application. Compliance was defined as full-time FAO use for 3 months and part-time use subsequently.