SA Orthopaedic Journal
On-line version ISSN 2309-8309
HORN, A; DIX-PEEK, SI and HOFFMAN, EB. The effect of two different plastering techniques on the rate of major surgery in idiopathic clubfoot. SA orthop. j. [online]. 2013, vol.12, n.4, pp. 28-32. ISSN 2309-8309.
BACKGROUND: The Ponseti technique of clubfoot manipulation and casting is reported to have almost eliminated the need for extensive surgery (posterior and posteromedial release) and surgical decision-making is now largely based on clinical assessment, as opposed to pre-operative radiographs. The Ponseti method of manipulation and casting was introduced at our institution in 2002, prior to which we used the Kite method. Both prior to, and following the introduction of Ponseti casting, surgical decision-making was based on pre-operative radiology, and intra-operative clinical assessment. METHODS: A retrospective comparative study was performed to compare the incidence of radical surgery following the use of the Kite method versus the Ponseti method. In addition, the accuracy of measured radiographic parameters in predicting which surgery was to be performed was investigated. RESULTS: The incidence of radical surgery decreased from 40% with the Kite method to zero with the Ponseti method. Of the four routinely measured radiographic angles, only the tibiocalcaneal angle and the talometatarsal angle significantly correlated with the extent of surgery performed. CONCLUSIONS: Using the Ponseti method greatly decreases the need for radical surgery in idiopathic clubfoot. Radiographic measurements do not influence surgical decision-making significantly.
Keywords : clubfoot; Ponseti; posteromedial release; radiographic; angles.