RESUMO
Ultrasound (US) can guide and confirm percutaneous release of the achilles tendon in the clubfoot. However, this technique may not always be available; therefore, surgeons' reported feelings of tendon release ("click" or "pop") and the Thompson sign could demonstrate that they are sensitive and reliable for confirming complete tendon release. The purpose of this study was to compare the reproducibility of clinical maneuvers that aim to detect the reported "click" or "pop" sensation by the surgeon and the Thompson sign after surgical release in percutaneous achilles tenotomy compare with US in patients with clubfoot. A cross-sectional reproducibility study of consecutive patients with idiopathic clubfoot was conducted. All the patients were scheduled to undergo tenotomy in the operating room using the standard percutaneous achilles tenotomy technique under sedation. The surgeon's reported surgical sensation ("click" or "pop") and Thompson signs were compared to the US assessment of the cut. The final Pirani score was used to predict recurrence risk and was correlated with the number of plaster casts and age. Forty-five feet were affected in 30 patients. Eighteen (60%) men. Age range: 1 to 60 months. The sensation of "click" or "pop" was recorded in 38 patients, and complete release was confirmed by US in 37 patients, for a sensitivity (Se) of 0.95 and specificity (Sp) of 0.63. Thompson signs were positive in 33 and 36 patients at 2 evaluations, with Se values of 0.87 and 0.92 and Sp values of 0.88 and 0.75, respectively. The Pirani final score, a predictor of recurrence risk, had an area under the curve of 0.80 (95% CIâ =â 0.63-0.97; Pâ =â .005), Seâ =â 0.78, and Spâ =â 0.56, with a cutoff point of 2.75. The feeling of achilles tendon release and Thompson sign had high sensitivity, prevalence, accuracy, and posttest probability. The confirmation of tendon release based on clinical signs could prevent the use of US.
Assuntos
Tendão do Calcâneo , Pé Torto Equinovaro , Recidiva , Tenotomia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Tendão do Calcâneo/cirurgia , Tendão do Calcâneo/diagnóstico por imagem , Pé Torto Equinovaro/cirurgia , Pé Torto Equinovaro/diagnóstico por imagem , Estudos Transversais , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Tenotomia/métodos , Ultrassonografia/métodosRESUMO
PURPOSE: To establish parameters and propose a radiographic classification for foot adduction/supination deformities to assist the indication of Garceau procedure. Secondly, to investigate whether the outcome of Garceau surgery depends on the initial treatment used, peritalar release, or the Ponseti method, and verify the maintenance of correction until skeletal maturity. METHODS: Prospective cohort study, with follow-up evaluations in 2009 and 2019. Fifty-three consecutive patients (71 feet) with idiopathic congenital clubfoot (ICCF) were divided into two groups according to the initial treatment used: peritalar release (group I) or Ponseti method (group II). All patients underwent Garceau procedure. The patients were evaluated clinically and radiographically using the American Orthopedic Foot Association (AOFAS) score for ankle and hindfoot. A radiographic classification is proposed based on the adduction by talo-first metatarsal angle on dorsoplantar view and supination by the elevation of the head of the first metatarsal on lateral view, both weight-bearing. RESULTS: In the first clinical evaluation, the mean score on the AOFAS was 87 points in group I and 86 points in group II. In the second evaluation, group I had mean AOFAS of 92 points and group II of 94 points. No statistical differences were found between the two groups, neither between the first and the second evaluation. In the radiographic evaluation, the adduction deformity obtained an average correction of 4° in group I and 3.6° in group II; in supination deformity, the average depression of the first metatarsal head in relation to the ground was 6.7 mm in group I and 7.5 mm in group II, with no statistical difference between the two evaluations, indicating the correction was maintained until skeletal maturity. CONCLUSION: Garceau transfer is capable of correcting residual deformities in adduction/supination of mild and moderate degrees, regardless of the initial treatment, and maintaining the correction until skeletal maturity. The proposed radiographic classification might help to objectively indicate the surgical procedure.
Assuntos
Pé Torto Equinovaro , Articulação do Tornozelo/cirurgia , Pé Torto Equinovaro/diagnóstico por imagem , Pé Torto Equinovaro/cirurgia , Humanos , Estudos Prospectivos , Transferência Tendinosa/métodos , Resultado do TratamentoRESUMO
OBJECTIVE: The aim of this study was to determine the healing time of Achilles tendon in pediatric patients treated with Achilles tenotomy with the Ponseti method in Shriners Childrens Hospital of Mexico, AC. MATERIAL AND METHODS: Experimental, analytical, prospective, longitudinal study of patients with a diagnosis of idiopathic congenital clubfoot treated with the Ponseti method with serial static and dynamic evaluation by ultrasound in real time with a Siemens Diagnostic Ultrasound System Sonoline 650, linear transducer 10.5 MHz of Achilles tendon before tenotomy and at three, six, nine and 12 weeks after the surgical treatment. RESULTS: A sample of 23 patients, 16 male and seven female, 16 with unilateral and seven with bilateral pathology was obtained, for a total of 39 feet, 18 right and 21 left, with a mean age of 8.3 ± 2.3 months. Before tenotomy, the width was 2.7 ± 0.42 mm; in week three, the average was 3 ± 0.39 mm; at six weeks, 2.92 ± 0.36 mm; ultrasound at nine weeks reported an average of 0.38 ± 2.84 mm, and 2.82 ± 0.39 mm at twelve weeks. They were compared using Students t presurgical width and at twelve weeks, without finding difference p 0.03. CONCLUSIONS: Although there is integrity at three weeks after Achilles tenotomy, complete repair is achieved at 12 weeks.
OBJETIVO: Determinar el tiempo de curación del tendón de Aquiles en pacientes pediátricos tratados mediante tenotomía de Aquiles con método Ponseti en el Hospital Shriners para Niños de México, AC. MATERIAL Y MÉTODOS: Estudio experimental, analítico, prospectivo, longitudinal de pacientes con diagnóstico de pie equino varo aducto congénito idiopático en tratamiento con método Ponseti con evaluación estática y dinámica mediante ecógrafo en tiempo real Siemens Diagnostic Ultrasound System Sonoline 650 con transductor lineal de 10.5 mHz seriada del tendón de Aquiles previa a la tenotomía y a las tres, seis, nueve y 12 semanas tras el tratamiento quirúrgico. RESULTADOS: Se obtuvo una muestra de 23 pacientes, 16 masculinos y siete femeninos, 16 con patología bilateral y siete unilateral, para un total de 39 pies, 18 derechos y 21 izquierdos, con una media de edad de 8.3 ± 2.3 meses. Previamente a la tenotomía, la anchura en corte longitudinal ultrasonográfico media fue de 2.7 ± 0.42 mm; en la semana tres, la media fue 3 ± 0.39 mm; a las seis semanas, 2.92 ± 0.36 mm; el ultrasonido de las nueve semanas reportó media de 2.84 ± 0.38 mm y a las 12 semanas, 2.82 ± 0.39 mm. Se compararon mediante t de Student el ancho prequirúrgico y a las 12 semanas, sin encontrarse diferencia p 0.03. CONCLUSIONES: La valoración ecográfica muestra integridad a las tres semanas posteriores a la tenotomía de Aquiles. Sin embargo, la reparación completa se logra a las 12 semanas.
Assuntos
Tendão do Calcâneo , Moldes Cirúrgicos , Pé Torto Equinovaro , Tenotomia , Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/cirurgia , Criança , Pé Torto Equinovaro/diagnóstico por imagem , Pé Torto Equinovaro/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Estudos Longitudinais , Masculino , Estudos Prospectivos , Resultado do Tratamento , UltrassonografiaRESUMO
Resumen: Objetivo: Determinar el tiempo de curación del tendón de Aquiles en pacientes pediátricos tratados mediante tenotomía de Aquiles con método Ponseti en el Hospital Shriners para Niños de México, AC. Material y métodos: Estudio experimental, analítico, prospectivo, longitudinal de pacientes con diagnóstico de pie equino varo aducto congénito idiopático en tratamiento con método Ponseti con evaluación estática y dinámica mediante ecógrafo en tiempo real Siemens Diagnostic Ultrasound System Sonoline 650 con transductor lineal de 10.5 mHz seriada del tendón de Aquiles previa a la tenotomía y a las tres, seis, nueve y 12 semanas tras el tratamiento quirúrgico. Resultados: Se obtuvo una muestra de 23 pacientes, 16 masculinos y siete femeninos, 16 con patología bilateral y siete unilateral, para un total de 39 pies, 18 derechos y 21 izquierdos, con una media de edad de 8.3 ± 2.3 meses. Previamente a la tenotomía, la anchura en corte longitudinal ultrasonográfico media fue de 2.7 ± 0.42 mm; en la semana tres, la media fue 3 ± 0.39 mm; a las seis semanas, 2.92 ± 0.36 mm; el ultrasonido de las nueve semanas reportó media de 2.84 ± 0.38 mm y a las 12 semanas, 2.82 ± 0.39 mm. Se compararon mediante t de Student el ancho prequirúrgico y a las 12 semanas, sin encontrarse diferencia p > 0.03. Conclusiones: La valoración ecográfica muestra integridad a las tres semanas posteriores a la tenotomía de Aquiles. Sin embargo, la reparación completa se logra a las 12 semanas.
Abstract: Objective: The aim of this study was to determine the healing time of Achilles tendon in pediatric patients treated with Achilles tenotomy with the Ponseti method in Shriners Children's Hospital of Mexico, AC. Material and methods: Experimental, analytical, prospective, longitudinal study of patients with a diagnosis of idiopathic congenital clubfoot treated with the Ponseti method with serial static and dynamic evaluation by ultrasound in real time with a Siemens Diagnostic Ultrasound System Sonoline 650, linear transducer 10.5 MHz of Achilles tendon before tenotomy and at three, six, nine and 12 weeks after the surgical treatment. Results: A sample of 23 patients, 16 male and seven female, 16 with unilateral and seven with bilateral pathology was obtained, for a total of 39 feet, 18 right and 21 left, with a mean age of 8.3 ± 2.3 months. Before tenotomy, the width was 2.7 ± 0.42 mm; in week three, the average was 3 ± 0.39 mm; at six weeks, 2.92 ± 0.36 mm; ultrasound at nine weeks reported an average of 0.38 ± 2.84 mm, and 2.82 ± 0.39 mm at twelve weeks. They were compared using Student's t presurgical width and at twelve weeks, without finding difference p > 0.03. Conclusions: Although there is integrity at three weeks after Achilles tenotomy, complete repair is achieved at 12 weeks.
Assuntos
Humanos , Masculino , Feminino , Lactente , Criança , Tendão do Calcâneo/cirurgia , Tendão do Calcâneo/diagnóstico por imagem , Pé Torto Equinovaro/cirurgia , Pé Torto Equinovaro/diagnóstico por imagem , Moldes Cirúrgicos , Tenotomia , Estudos Prospectivos , Seguimentos , Estudos Longitudinais , Ultrassonografia , Resultado do TratamentoRESUMO
AIMS: Our aim was to describe the mid-term appearances of the repair process of the Achilles tendon after tenotomy in children with a clubfoot treated using the Ponseti method. PATIENTS AND METHODS: A total of 15 children (ten boys, five girls) with idiopathic clubfoot were evaluated at a mean of 6.8 years (5.4 to 8.1) after complete percutaneous division of the Achilles tendon. The contour and subjective thickness of the tendon were recorded, and superficial defects and its strength were assessed clinically. The echogenicity, texture, thickness, peritendinous irregularities and potential for deformation of the tendon were evaluated by ultrasonography. RESULTS: The appearance of the Achilles tendon was slightly abnormal, with more thickening and less conspicuous contours than a normal tendon. Its strength was grossly normal, with no insufficiency of the triceps surae. Ultrasonographic findings revealed a mild fusiform thickening in 12 children (80%). The tissue at the site of the repair had a slightly hypoechoic, fibrillar quality with hyperechoic striation and the anterior contour was irregular and blurred. There was a focal narrowing within the healing tissue in two children. CONCLUSION: This mid-term evaluation of the ability of the Achilles tendon to repair after division suggests a combination of intrinsic and extrinsic mechanisms. There were minor abnormalities which did not appear to affect function. Cite this article: Bone Joint J 2017;99-B:139-44.
Assuntos
Tendão do Calcâneo/cirurgia , Pé Torto Equinovaro/cirurgia , Tenotomia/métodos , Tendão do Calcâneo/diagnóstico por imagem , Pré-Escolar , Pé Torto Equinovaro/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Variações Dependentes do Observador , Estudos Prospectivos , Resultado do Tratamento , Ultrassonografia , Cicatrização/fisiologiaRESUMO
INTRODUCTION: Congenital Talipes Equinovarus (CTEV) or clubfoot is one of the most common congenital abnormalities(1,2). Early diagnosis by means of ultrasonography allows an opportune intervention and improves the deformity's correction prognosis. GOAL: To describe patients diagnosed with CTEV by means of prenatal sonographies between 2003 and 2012 in Bogotá (Colombia) at both the Institute de Ortopedia Infantil Roosevelt (IOIR) and one of the authors' private office. METHODS: A descriptive, retrospective study on the focus population was made. The equality of the data of the quantitative variables in distance measure was analysed by the Kolmogorov-Smirnov test. For the variables "prenatal diagnoses" and "days from the start of the treatment" the Mann-Whitney U test was used. Finally, an analysis was made by means of the SPSS Statistics software package, version 18.0. RESULTS: 178 patients met the selection criteria. 34.3% of the patients had a prenatal diagnosis by ultrasonography (n=61). Regarding the number of prenatal ultrasounds performed, there were statistically significant differences between the patients with a CTEV prenatal diagnoses and those whose diagnoses came after birth, being higher in the first group (p<0.001). The number of days before the treatment started once the pre or postnatal diagnosis was done was also a subject of study. Significant differences were found in the treatment start between patients with a prenatal diagnosis (mean of 9.9 days) and those diagnosed after birth (mean of 30 days) (p<0.001). CONCLUSIONS: prenatal diagnosis by foetal ultrasonography contributes to an early detection of musculoskeletal abnormalities such as CTEV and promotes an early intervention of the patient.
Assuntos
Pé Torto Equinovaro/diagnóstico por imagem , Pé Torto Equinovaro/epidemiologia , Diagnóstico Precoce , Ultrassonografia Pré-Natal/métodos , Pé Torto Equinovaro/terapia , Estudos de Coortes , Colômbia/epidemiologia , Países em Desenvolvimento , Feminino , Humanos , Incidência , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos , Medição de Risco , Ultrassonografia Pré-Natal/estatística & dados numéricosRESUMO
Richieri-Costa and Pereira syndrome, described in 1992, comprises short stature, Robin sequence, cleft mandible, limb malformations, and short larynx, deformed or lack of epiglottis, and abnormal aryepiglottic folds. There are 32 reported cases, only one described outside Brazil. We describe a 4-month-old boy with the most severe phenotype yet reported.
Assuntos
Pé Torto Equinovaro/patologia , Deformidades Congênitas da Mão/patologia , Síndrome de Pierre Robin/patologia , Adolescente , Adulto , Brasil , Pé Torto Equinovaro/diagnóstico por imagem , Feminino , Deformidades Congênitas da Mão/diagnóstico por imagem , Humanos , Lactente , Masculino , Fenótipo , Síndrome de Pierre Robin/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
A simplified standard setting of the circular external fixator allows correction of all the complex deformities of recurrent clubfoot with minimal surgical intervention and no major complications. In those cases where additional corrective arthrodesis is necessary, it is performed with minimal bone resection because the severe deformities of the foot and ankle have already been corrected.
Assuntos
Pé Torto Equinovaro/reabilitação , Pé Torto Equinovaro/cirurgia , Fixadores Externos , Osteotomia/métodos , Fatores Etários , Articulação do Tornozelo/cirurgia , Artrodese/métodos , Moldes Cirúrgicos , Criança , Pré-Escolar , Pé Torto Equinovaro/diagnóstico por imagem , Terapia Combinada , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Manipulação Ortopédica/métodos , Osteogênese por Distração/métodos , Osteotomia/instrumentação , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Radiografia , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Recidiva , Medição de RiscoRESUMO
UNLABELLED: The Ponseti technique for treating clubfoot has been popularized for idiopathic clubfoot and more recently several syndromic causes of clubfoot. We asked whether it could be used to treat recurrent clubfoot following failed posteromedial release. We retrospectively reviewed 58 children (83 clubfeet) treated by the Ponseti technique for recurrent deformity after posteromedial release in three centers. The minimum followup was 24 months (average, 45 months; range, 24-80 months). We determined initial and final Pirani scores and range of motion of the ankle and subtalar joint. Plantigrade and fully corrected feet were obtained in 71 feet (86%); 11 feet obtained partial correction; one patient failed treatment and underwent another posteromedial release. Recurrences occurred in nine patients (12 feet or 14%). Initial Pirani scores improved in all but one patient; severity of deformity was also inferred by number of casts used for treatment. The age at treatment and numbers of casts did not influence the scores of Pirani et al. The scores were similar among the three orthopaedic surgeons. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Assuntos
Tendão do Calcâneo/cirurgia , Articulação do Tornozelo/fisiopatologia , Braquetes , Moldes Cirúrgicos , Pé Torto Equinovaro/terapia , Manipulações Musculoesqueléticas , Transferência Tendinosa , Adolescente , Fatores Etários , Fenômenos Biomecânicos , Brasil , Criança , Pré-Escolar , Pé Torto Equinovaro/diagnóstico por imagem , Pé Torto Equinovaro/fisiopatologia , Terapia Combinada , Europa (Continente) , Feminino , Humanos , Lactente , Masculino , Projetos Piloto , Radiografia , Amplitude de Movimento Articular , Recidiva , Estudos Retrospectivos , Índice de Gravidade de Doença , Articulação Talocalcânea/fisiopatologia , Resultado do TratamentoRESUMO
BACKGROUND: Most cases of congenital clubfoot treated with the Ponseti technique require percutaneous Achilles tenotomy to correct the residual equinus. Clinical evidence suggests that complete healing occurs between the cut tendon stumps, but there have not yet been any detailed studies investigating this reparative process. This study was performed to assess Achilles tendon repair after percutaneous section to correct the residual equinus of clubfoot treated with the Ponseti method. METHOD: A prospective study analyzed 37 tenotomies in 26 patients with congenital clubfoot treated with the Ponseti technique, with a minimum follow-up of 1 year after the section. The tenotomy was performed percutaneously with a large-bore needle bevel with patient sedation and local anesthesia. Ultrasonographic scanning was performed after section to ascertain that the tenotomy had been completed and to measure the stump separation. In the follow-up period, the reparative process was followed ultrasonographically and assessed at 3 weeks, 6 months, and 1 year posttenotomy. RESULTS: The ultrasonography performed immediately after the procedure showed that in some cases, residual strands between the tendon ends persisted, and these were completely sectioned under ultrasound control. A mean retraction of 5.65 mm+/-2.26 mm (range, 2.3 to 11.0 mm) between tendon stumps after section was observed. Unusual bleeding occurred in one case and was controlled by digital pressure, with no interference with the final treatment. After 3 weeks, ultrasonography showed tendon repair with the tendon gap filled with irregular hypoechoic tissue, and also with transmission of muscle motion to the heel. Six months after tenotomy, there was structural filling with a fibrillar aspect, mild or moderate hypoechogenicity, and tendon scar thickening when compared with a normal tendon. One year after tenotomy, ultrasound showed a fibrillar structure and echogenicity at the repair site that was similar to a normal tendon, but with persistent tendon scarring thickness. CONCLUSIONS: There is a fast reparative process after Achilles tendon percutaneous section that reestablishes continuity between stumps. The reparative tissue evolved to tendon tissue with a normal ultrasonographic appearance except for mild thickening, suggesting a predominantly intrinsic repair mechanism.
Assuntos
Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/cirurgia , Pé Torto Equinovaro/diagnóstico por imagem , Pé Torto Equinovaro/cirurgia , Procedimentos Ortopédicos/métodos , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Resultado do Tratamento , UltrassonografiaRESUMO
We describe an apparently new genetic syndrome in six members of a family living in a remote area in Northeastern Brazil. This syndrome comprises: short stature due to a marked decrease in the length of the lower limbs (predominantly mesomelic with fibular agenesis/marked hypoplasia), grossly malformed/deformed clubfeet with severe oligodactyly, upper limbs with acromial dimples and variable motion limitation of the forearms and/or hands, severe nail hypoplasia/anonychia sometimes associated with mild brachydactyly and occasionally with pre-axial polydactyly. This syndrome is apparently distinct from the syndrome of brachydactyly-ectrodactyly with fibular aplasia or hypoplasia (OMIM 113310), the syndrome of fibular aplasia or hypoplasia, femoral bowing and poly-, syn-, and oligodactyly (OMIM 228930), and from other previously described conditions exhibiting fibular agenesis/hypoplasia.
Assuntos
Pé Torto Equinovaro/complicações , Anormalidades Congênitas/patologia , Fíbula/anormalidades , Unhas Malformadas/complicações , Idoso , Brasil , Criança , Pé Torto Equinovaro/diagnóstico por imagem , Anormalidades Congênitas/diagnóstico por imagem , Feminino , Fíbula/diagnóstico por imagem , Geografia , Humanos , Masculino , Pessoa de Meia-Idade , Unhas Malformadas/diagnóstico por imagem , Linhagem , Radiografia , SíndromeRESUMO
A series of 50 patients with 71 clubfeet treated surgically was evaluated after exclusion of individuals with associated malformations, syndromes, neurological disorders, previous surgery and age over 30 months at the time of the surgical procedure. They underwent soft-tissue releases that addressed all the components of the deformity, including, when necessary, the calcaneocuboid joint. The age of the patients at the time of the surgery ranged from 6 to 26 months and the mean follow-up period was 77.03 months. The scores resulting from the application of the functional rating system designed by Laaveg and Ponseti were compared with several radiological parameters described in the medical literature to verify the degree of statistical association between these variables. The talo-first metatarsal angle, the calcaneal-second and fifth metatarsal angles were the only radiological measurements that correlated well with the functional score.
Assuntos
Pé Torto Equinovaro/diagnóstico por imagem , Pé Torto Equinovaro/cirurgia , Avaliação de Resultados em Cuidados de Saúde/métodos , Procedimentos de Cirurgia Plástica/métodos , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Radiografia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
Partial deletion of the long arm of one of the chromosomes 13 is an exceedingly rare condition. We report such a case in a 32-week fetus presenting with polyhydramnios, growth restriction and multiple structural defects including alobar holoprosencephaly, facial abnormalities, clubfoot, clinodactyly and thumb agenesis. Fetal blood sampling revealed a 46,XY, del(13)(q22 --> qter) abnormal male karyotype. Postmortem examination confirmed the prenatal findings and showed other manifestations of the syndrome. To our knowledge, this case represents the first in which the prenatal ultrasound detection of holoprosencephaly in association with distal limb abnormalities led to the prenatal diagnosis of the 13q- syndrome.
Assuntos
Deleção Cromossômica , Cromossomos Humanos Par 13 , Holoprosencefalia/diagnóstico por imagem , Polegar/anormalidades , Ultrassonografia Pré-Natal , Adulto , Pé Torto Equinovaro/diagnóstico por imagem , Feminino , Morte Fetal , Humanos , Poli-Hidrâmnios , Gravidez , Polegar/diagnóstico por imagemRESUMO
We reviewed the results of 101 talectomies in 56 patients with arthrogrypotic clubfeet. The average age at the time of surgery was 4.3 years and the mean follow-up was 6 years. Talectomy was performed as a primary procedure in 16 feet and as a salvage procedure in 85 feet that underwent other surgical procedures before talectomy. We graded our results as good when the foot was plantigrade, able to wear regular shoes, pain free, and, very important, patient satisfaction. We used a chi2 statistical test and, after comparing results with age <4 to >4 years at time of surgery, tendo Achilles tenotomy, time of casting, radiological complete excision of talus, and transcalcaneal pin placement, only the immobilization time needed to be statistically significant to achieve a good result. We conclude that feet must be individualized for treatment and that, after reduction of the calcaneus in the mortise, a short leg cast must be placed for 8 weeks to maintain position and alignment.
Assuntos
Artrogripose/complicações , Pé Torto Equinovaro/cirurgia , Tálus/cirurgia , Tendão do Calcâneo/cirurgia , Fatores Etários , Tornozelo/cirurgia , Calcâneo/cirurgia , Criança , Pré-Escolar , Pé Torto Equinovaro/complicações , Pé Torto Equinovaro/diagnóstico por imagem , Interpretação Estatística de Dados , Feminino , Seguimentos , Humanos , Lactente , Masculino , Aparelhos Ortopédicos , Radiografia , Tendões/cirurgia , Fatores de TempoRESUMO
Neglected congenital clubfoot in adults has been described in literature, but is not common to see adult patients with this orthopaedic disorder in developed countries with 30 years of follow-up. We report an asymptomatic case of neglected congenital clubfoot in an adult, who is incidentally seeking treatment for her 18-month-old son with congenital clubfoot. Although the cosmetic appearance is unacceptable, this mother remarkably has no functional limitations and for this reason she refuses any surgical treatment for her foot. To our knowledge, this is the first report of an untreated congenital clubfoot with 30 years follow-up.
Assuntos
Pé Torto Equinovaro/diagnóstico por imagem , Pé Torto Equinovaro/fisiopatologia , Adulto , Feminino , Seguimentos , Humanos , México , Pobreza , Radiografia , Índice de Gravidade de Doença , Fatores de TempoRESUMO
In 1970, Aarskog described a rare X-linked developmental disorder characterized by short stature in association with a variety of structural anomalies involving mainly the face, distal extremities, and external genitalia (faciodigitogenital syndrome). The major facial manifestations of this syndrome include hypertelorism, broad forehead, broad nasal bridge, short nose with anteverted nostrils, long philtrum, widow's peak hair anomaly, and ocular and ear anomalies. Limb abnormalities consist of short broad hands, brachydactyly, interdigital webbing, hypoplasia of the middle phalanges, proximal interphalangeal joint laxity with concomitant flexion and restriction of movement of distal interphalangeal joints, and flat broad feet with bulbous toes. Genital anomalies are characteristics and include shawl scrotum, cryptorchidism, and inguinal hernia. Most affected patients have normal intelligence, but some authors have noted mild neurodevelopmental delay in up to 30% of the cases. We describe a case of Aarskog syndrome diagnosed prenatally by sonography at 28 weeks' gestation in a high-risk pregnancy for this disorder.
Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto , Pé Torto Equinovaro/diagnóstico por imagem , Fácies , Feminino , Genitália Masculina/anormalidades , Genitália Masculina/diagnóstico por imagem , Deformidades Congênitas da Mão/diagnóstico por imagem , Humanos , Hidronefrose/diagnóstico por imagem , Hipertelorismo/diagnóstico por imagem , Masculino , Pescoço/anormalidades , Gravidez , SíndromeRESUMO
Surgical correction of the neglected, and severely deformed clubfoot in the adult is necessary to achieve plantigrade, pain free, and cosmetically acceptable feet. Also, it is important that the patient is able to wear shoes and participate in a more active and normal life. Three adult immigrants with neglected clubfoot underwent surgical correction for the first time. Posterior medial plantar soft tissue release and a double arthrodesis involving calcaneal cuboid wedge resection with talonavicular fusion have been effective in removing rearfoot varus, providing minimal shortening, and restoring the foot to a normal plantigrade position.
Assuntos
Pé Torto Equinovaro/cirurgia , Atividades Cotidianas/classificação , Adulto , Pé Torto Equinovaro/diagnóstico por imagem , Pé Torto Equinovaro/genética , Países em Desenvolvimento , República Dominicana/etnologia , Emigração e Imigração , Marcha , Humanos , Índia/etnologia , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Porto Rico/etnologia , Radiografia , Estados UnidosRESUMO
Preoperative angiography in 30 uncorrected clubfeet demonstrated abnormal vascular patterns in all but two limbs with hypoplasia or premature termination of the anterior tibial and medial plantar arteries in the remainder. Postoperative Doppler studies in nine of the limbs with abnormal vessels indicated that these arteries were present. We suggest that the continuous-wave Doppler technique is less useful for identifying major arteries than either dissection or angiography. Furthermore, arterial dysgenesis may play a role in the etiology of clubfoot. Since the posterior tibial artery usually provides the sole arterial supply to the foot, this vessel must be preserved at surgery and during subsequent ankle dorsiflexion.