Surgical treatment for myelodysplastic clubfoot

Zuccon, Alexandre; Cardoso, Sérgio Inácio Cristiano; Abreu, Fábio Peluzo; Fernandes, Antonio Carlos

doi:10.1016/j.rboe.2014.10.006

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ortopedia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Articles • Rev. bras. ortop. 49 (6) • Nov-Dec 2014 • https://doi.org/10.1016/j.rboe.2014.10.006 copy

Surgical treatment for myelodysplastic clubfoot^☆ ☆ Please cite this article as: Zuccon A, Cardoso SIC, Abreu FP, Fernandes AC. Tratamento cirúrgico do pé equinovaro mielodisplásico. Rev Bras Ortop. 2014;49:653–660. ,^☆☆ ☆☆ Work developed at the Association for Disabled Children's Care (AACD), São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

To analyze the results from surgical treatment of 69 cases of clubfoot in 43 patients with myelodysplasia according to clinical and radiographic criteria, at our institution between 1984 and 2004.

Methods:

This was a retrospective study involving analysis of medical files, radiographs and consultations relating to patients who underwent surgical correction of clubfoot. The surgical technique consisted of radical posteromedial and lateral release with or without associated talectomy.

Results:

The patients' mean age at the time of the surgery was four years and two months, and the mean length of postoperative follow-up was seven years and two months. Satisfactory results were achieved in 73.9% of the feet and unsatisfactory results in 26.1% (p < 0.0001).

Conclusion:

Residual deformity in the immediate postoperative period was associated with unsatisfactory results. Opening of the Kite (talocalcaneal) angle in feet that only underwent posteromedial and lateral release, along with appropriate positioning of the calcaneus in cases that underwent talectomy, was the radiographic parameter that correlated with satisfactory results.

Myelomeningocele; Clubfoot; Acquired deformities of the foot

No.	Side	Age	Surgical technique	Result	Length of time after operation
1	R/L	1 Y	PMLR	+/+	19 Y + 3 M
2	R/L	6 Y	PMLR + TAL + SLC	+/+	6 Y
3	L	2 Y + 8 M	PMLR + SLC	+	18 Y
4	R/L	2 Y + 2 M	PMLR	+/+	16 Y
5	R/L	3 Y + 2 M	PMLR	+/−	11 Y
6	L	5 Y + 7 M	PMLR + TAL	−	9 Y
7	R	6 Y	PMLR + TAL	+	10 Y + 10 M
8	L	4 Y	PMLR + TAL	−	10 Y
9	L	2 Y + 9 M	PMLR + TAL + SLC	−	7 Y
10	R/L	3 Y	PMLR + SLC	−/+	7 Y + 6 M
11	R/L	2 Y + 5 M	PMLR + TAL + SLC	+/−	7 Y
12	R/L	1 Y + 8 M	PMLR + TAL + SLC	+/+	6 Y + 4 M
13	R/L	3 Y + 1 M	PMLR	−/−	5 Y
14	R	1 Y + 9 M	PMLR + TAL + SLC	+/+	4 Y + 1 M
15	R/L	9 Y + 8 M	PMLR + TAL + SLC	+/+	6 Y
16	R/L	3 Y + 2 M	PMLR	+/+	8 Y + 6 M
17	R/L	7 Y + 3 M	PMLR + TAL + SLC	+/+	3 Y
18	R	6 Y	PMLR + TAL + SLC	+	4 Y + 11 M
19	R/L	7 Y + 4 M	PMLR	+/+	3 Y + 8 M
20	R/L	5 Y + 8 M	PMLR + TAL + SLC	+/+	7 Y
21	R/L	1 Y + 6 M	PMLR + SLC	+/+	5 Y
22	R/L	1 Y + 7 M	PMLR + TAL + SLC	+/+	3 Y + 10 M
23	L	3 Y + 9 M	PMLR + SLC	−	8 Y + 9 M
24	R/L	2 Y + 6 M	PMLR + SLC	−/−	8 Y
25	R/L	2 Y + 1 M	PMLR + TAL + SLC-D	+/+	8 Y + 10 M
26	R	1 Y + 2 M	PMLR	−	7 Y
27	R/L	2 Y	PMLR	+/+	3 Y
28	R/L	1 Y + 6 M	PMLR + TAL	+/+	2 Y
29	L	11 Y + 5 M	PMLR + TAL	−	2 Y + 2 M
30	R	4 Y + 6 M	PMLR + TAL + SLC	+	2 Y
31	L	6 Y	PMLR + SLC	+	9 Y
32	L	2 Y	PMLR + TAL + SLC	+	19 Y
33	R/L	4 Y + 3 M	PMLR + TAL-D	+/−	7 Y
34	L	1 Y + 5 M	PMLR	+	2 Y
35	R/L	2 Y + 6 M	PMLR	+/−	8 Y
36	R/L	2 Y	PMLR	+/+	2 Y
37	R/L	3 Y	PMLR	+/+	2 Y + 4 M
38	L	13 Y	PMLR + SLC	+	2 Y + 1 M
39	R	6 Y	PMLR + TAL + SLC	+	3 Y + 6 M
40	R	7 Y	PMLR	+	3 Y
41	L	7 Y + 2 M	PMLR + SLC	+	2 Y
42	R/L	2 Y	PMLR + TAL + SLC	+/−	3 Y + 6 M
43	R/L	5 Y + 8 M	PMLR + SLC	−/−	4 Y + 2 M

Complication	Number of feet	Percentage
Suture dehiscence^a a Note: In seven feet, more than one complication occurred.	16	39.1%
Superficial infection^a a Note: In seven feet, more than one complication occurred.	6	14.6%
Deep infection^a a Note: In seven feet, more than one complication occurred.	3	7.3%
Migration of wires	3	7.3%
Skin distress^a a Note: In seven feet, more than one complication occurred. (circulatory)	3	7.3%
Hypercorrection	9	22%
Aseptic necrosis of talus	1	2.4%
Total	41	100%

Result	Residual deformity
Result	Present	Absent	Total
Unsatisfactory	8 feet^* * p = 0.00004 (Fisher test).	10 feet	18 feet
Satisfactory	1 foot	50 feet	51 feet
Total	9 feet	60 feet	69 feet

Result	Kite
Result	Open	Closed	Total
Satisfactory	21 feet	1 foot	22 feet
Unsatisfactory	1 foot	5 feet	6 feet
Total	22 feet	6 feet	28 feet

Result	Radiography
Result	Position +	Position −	Total
Satisfactory	14	1	15
Unsatisfactory	1	1	2
Total	15	2	17

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author. E-mail: alezuccon@hotmail.com (A. Zuccon).