Comparison of Standard and Accelerated Ponseti Technique in the Treatment of Idiopathic Clubfoot at a Regional Orthopaedic Hospital in Nigeria

Volume 7 | Issue 1 | January-April 2021 | Page: 10-15 | Anikwe I.A, Lasebikan O.A, Enweani U.N

Authors: I. A. Anikwe MBBS, FMC Ortho. [1], O. A. Lasebikan MBCHB, MPH, MBA, FWACS, FMC Ortho, FICS [2],
U. N. Enweani MBBS, FMCS, FMCOrtho, FWACS, FICS [3]

[1] Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
[2] Department of Orthopaedics, National Orthopedic Hospital, Enugu, Nigeria.
[3] Consultant Orthopedic Surgeon, City Hospital Enugu, Nigeria.

Address of Correspondence
Dr. Omolade. A. Lasebikan,
Department of Orthopaedics, National Orthopedic Hospital, Enugu, Nigeria.
Email: ladelash@yahoo.com

Abstract

Introduction: Congenital clubfoot is a developmental deformity of the foot. Management by the Ponseti method has been shown to be produce better results with fewer complications than traditional surgical methods. Some studies have shown that shorter intervals of serial manipulation/casting provide similar outcome to standard Ponseti technique. This study compared management outcome using an accelerated twice weekly technique, with standard weekly Ponseti casting.
Methodology: A prospective comparative study was conducted involving 62 patients with 90 clubfeet. From the study, 48 clubfeet in 34 patients were managed with standard Ponseti technique (weekly manipulation and casting), while 42 clubfeet in 28 patients were managed with accelerated Ponseti technique (twice weekly manipulation and casting). Pirani score was used for initial assessment and for follow-up.
Results: Children were 1 month to 36 months of age at the time of commencement of treatment. Majority of patients were male, (63%). The average number of casts did not differ significantly between the treatment groups (p = 0.13). The accelerated Ponseti technique patients were therefore able to complete their treatment within a significantly shorter period than those who went through the standard Ponseti protocol. The standard group had mean duration of correction of 29.65±11.69 days and 12.36±5.45 days for the accelerated group (p<0.001). The episodes of early relapses were 2.1% in the standard group and 2.4% in the accelerated group. The rates of complications were comparable between the groups.
Conclusion: Treatment of congenital clubfeet using the twice weekly casting appears to provide comparable outcomes to the weekly Ponseti casting with a significant reduction in the duration of the casting phase.
Keywords: Clubfoot; Pirani score; Ponseti technique; Accelerated.

References 

1. Morrissy RT, Weinstein SL. Clubfoot (Congenital Talipes Equinovarus) Lovell and Winter’s Paediatric Orthopaedics, 6th edition, Lippincott Williams and Wilkins, Philadelphia, 2006; 1262-1273.
2. Bridgens J, Kiely N. Current Management of Clubfoot (Congenital Talipes Equinovarus). British Medical Journal, 2010; 340: 308-311.
3. Dobbs MB, Gurnett CA. Update on Clubfoot: Etiology and Treatment. Clin Orthop Relat Res, 2009; 467(5) 1146-1153.
4. Solomon L, Warwick D. Congential Talipes Equinovarus (Idiopathic Clubfoot). Apley’s System of Orthopaedics and Fractures, 9th ed, Hodder Arnold, an Hachette UK company, London, 2010; 591-595.
5. Kampa R, Binks K, Dunkley M, Coates C. Multidisciplinary Management of Clubfeet Using the Ponseti method in a District General Hospital Setting. Journal of child Orthopaedics, 2008; 2:463-467.
6. Dobbs MB, Nunley R, Schoenecker PL. Long-Term Follow-up of Patients with Clubfeet Treated with Extensive Soft Tissue Release. J Bone Joint Surg (Am), 2006; 88:986-996.
7. Siapkara A, Duncan R. Congenital Talipes Equinovarus: A review of Current Management. J Bone Joint Surg (Br), 2007; 89-B: 995-1000.
8. Dyer PJ, Davis N. The Role of the Pirani Scoring System in the Management of Clubfoot by the Ponseti Method. J Bone joint Surg (Br), 2006; 88-B: 1082-1084.
9. Herzenberg JE, Radler C, Bor N. Ponseti versus Traditional Methods of Casting for Idiopathic Clubfoot. J Pediatr Orthop, 2002; 22:517-521.
10. Ponseti IV. Common Errors in the Treatment of Congential Clubfoot. International orthopaedic (SICOT), 1997; 21:137-141.
11. Morcuende JA, Abbasi D, Dolan LA, Ponseti IV. Results of an Accelerated Ponseti Protocol for Cubfoot. J Pediatr Orthop, 2005;25:623-626.
12. Ponseti IV. Current concepts review: Treatment of Congenital Clubfoot. J Bone Surg, Inc, 1992; 74-A: 448-454.
13. Cosma D, Vasilescu D, Vasilescu D, Valeanu M. Comparative results of the conservation Treatment in Clubfoot by two different protocol. J Pediat. Orthop B, 2007; 16:317-321
14. Ukoha U, Egwu OA, Okafor IJ, Ogugua PC, Udemezue OO, Olisah R et al. Incidence of congenital talipes equinovarus among children in Southeast Nigeria. Int. J. Biol Med. Res. 2011; 2(3): 712-715.
15. Adewole OA, Williams OM, Kayode MO, Shoga MO, Giwa SO. Early Experience with Ponseti Clubfoot Management in Lagos, Nigeria. East Cent.Afri.J.surg. 2014; 19(2): 72-77.
16. Harnett P, Freeman R, Harrison WJ, Brown LC, Beckles. An Accelerated Ponseti versus standard Ponseti method: A Prospective Randomized Controlled Trial. J Bone Joint Surg B. 2011; 93(3): 404-408.
17. Sharma P, Yadav V, Verma R, Gohiya A, Gaur S. Comparative Analysis of Results Between Conventional and Accelerated Ponseti Technique for Idiopathic Congenital Clubfoot. OrthopJMPC 2016;22(1):3-7.
18. Elgohary HAS, Abulsaad M. Traditional and accelerated Ponseti technique: a comparative study. Eur J Orthop Surg Traumatol. 2015.
19. Ibraheem GH, Adegbehingbe OO, Babalola OM, Agaja SB, Ahmed BA, Olawepo A et al. Evaluation of an Accelerated Ponseti protocol for the treatment of Talipesequinovarus in Nigeria. East Cent.Afr.J.surg. 2016;22(1): 28-38.
20. Changulani M, Garg NK, Rajagopal TS, Bass A, Nayagam SN, Sampath J et al. Treatment of Idiopathic Clubfoot using Ponseti Method: Initial experience. J Bone Joint Surg Br. 2006;88-B: 1385-1387.
21. Xu RJ. A modified Ponseti method for the treatment of idiopathic clubfoot: A preliminary report. J PediatrOrthop. 2011; 31: 317-319.

How to Cite this Article: Anikwe I.A, Lasebikan O.A, Enweani U.N | Comparison of Standard and Accelerated Ponseti Technique in the Treatment of Idiopathic Clubfoot at a Regional Orthopaedic Hospital in Nigeria | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 10-15.

(Abstract)      (Full Text HTML)      (Download PDF)

Supracondylar Humerus Fracturetreated With Closed Reduction and Percutaneous Cross Pinning Technique in Children

Volume 7 | Issue 1 | January-April 2021 | Page: 06-09 | Sanjay Kumar Meena, Ashok Tiwari, Dinesh Kumar Bairwa, Bharat Sharma

Authors: Sanjay Kumar Meena MS Orth. [1], Ashok Tiwari MS Orth. [1],
Dinesh Kumar Bairwa MS Orth. [1], Bharat Sharma  MS Orth. [2]

[1] Department of Orthopaedic, Government Medical College, Kota, Rajasthan.
[2] Department of Orthopaedic, Government Medical College, Pali, Rajasthan.

Address of Correspondence
Dr. Sanjay Kumar Meena,
Senior Resident, Department of Orthopaedic, Government Medical College, Kota, Rajasthan.
E-mail: drsanjayroop@gmail.com

Abstract

Introduction: Supracondylar fractures of the humerus are the most frequently occurring elbow fractures in children. They account for approximately 50-70% of all fractures around the elbow. The peak incidence is between 5 and 6 years of age. The incidence of supracondylar fractures amongst girls are on the rise.
Patients and Methods: 75 patients with a closed supracondylar humerus fracture were treated by closed reduction and percutaneous crossed Kirschner wire fixation (2 lateral and one medial entry) technique. All fractures were treated by general orthopaedic surgeons with no specialised training in paediatric orthopaedic surgery.
Results: Out of the 71 children available for follow-up, the outcomes were excellent in 55 patients, good in10, fair in 4, and poor in 2 patients.
Conclusions: We found closed reduction and percutaneous cross-pinning for the treatment of Type II and III supracondylar fractures of humerus in children (Modified Gartland Classification) to be an effective method of treatment. The outcomes obtained in our study suggest that childhood supracondylar humerus fractures can be managed successfully by general orthopaedic surgeons with comparable results to those achieved in tertiary centres dedicated to paediatric orthopaedic care.
Keywords: Children; Humerus; Supracondylar fracture.

References 

1. Pathania VP, Dubey N, Gupta S. Treatment of Displaced Supracondylar Fracture of Humerus in Children by Lateral Entry Pinning versus Cross Pinning. Int J Sci Stud 2016;4(1):70-74.
2. Cheng JC, Lam TP, Maffulli N. Epidemiological features of supracondylar fractures of the humerus in Chinese children. J PediatrOrthop B, 2001;10(1):63-67.
3. Cheng JC, Lam TP, Shen WY. Closed reduction and percutaneous pinning for type III displaced supracondylar fractures of the humerus in children. J Orthop Trauma 1995; 9(6):511-515.
4. Farnsworth CL, Silva PD, Mubarak SJ. Etiology of supracondylar humerus fractures. J PediatrOrthop 1998;18(1):38-42.
5. Higaki T, Ikuta Y. The new operation method of the dome osteotomy for four children with varus deformity of the elbow joint. J JpnOrthop 1982;31:300-335
6. Minkowitz B 1. Busch MT. Supracondylar fracture of humerus,current trends and controversies. Orthop Clin North Am1994;25:581-94
7. Pirone A, Graham HK, Krajbich JI (1988) Management of displaced extension-type supracondylar fractures of the humerus in children. J Bone Joint Surg Am 70:641–650 3.
8. Howard A, Mulpuri K, Abel MF et al (2012) The treatment of pediatric supracondylar humerus fractures. J Am Acad Orthop Surg 20:320–327 4.
9. Skaggs DL, Sankar WN, Albrektson J et al (2008) How safe is the operative treatment of Gartland type 2 supracondylar humerus fractures in children? J Pediatr Orthop 28:139–141
10. Tellisi N, Abusetta G, Day M et al (2004) Management of Gartland’s type III supracondylar fractures of the humerus in children: the role audit and practice guidelines. Injury 35:1167– 1171
11. Khan MS, Sultan S, Ali MA, Khan A et al 2005) Comparison of percutaneous pinning with casting in supracondylar humeral fractures in children. 17(2):33-6.
12. Muhammad Salim, ZakaUllah Malik, Ejaz Ashraf Mallhiet al (2013)Outcome of Close Reduction and Percutaneous Pinning In Displaced Pediatric Supracondylar Fracture of Humerus Assessed By Flynn’s Criteria, Journal of Surgery Pakistan (International). 18(3) :121124
13. Khan-D, Khan-A, Amanullah -Aet al(2016) outcome of closed reduction and percutaneous pinning in supracondylar type 11 and type 111 fractures in children Gomal J Medi Sci . 14:67-70
14. Swenson AL et al(1948) The treatment of supracondylarfractures of the humerus by Kirshner wire transfixation. J Bone Joint Surg Am. 30A(4):993-7.
15. Webb AJ, Sherman FC et al (1989) Supracondylar fracturesof the humerus in children. J PediatrOrthop .9(3):315-25.
16. Boyd DW, Aronson DD et al(1992) Supracondylar fracturesof the humerus: a prospective study of percutaneouspinning. J PediatrOrthop . 12:789-94.
17. Mehserle WL, Meehan PL,et al (1991) Treatment of the displaced displaced supracondylar fracture of the humerus(type III) with closed reduction and percutaneous cross-pin fixation. J PediatrOrthop .11(6):705-11
18. Awal Hakeem, Naji Ullah Khan, Tamjeed Gul, Faheem Ullah et al( 2010 ) Closed reduction and percutaneous pinning with crossed k- wire in type 111 supracondylar fracture of humerus in children Pak J Surg . 26(1):10-12
19. Rajesh Govindasamy1*, Ramkumar Gnanasundaram2, Saravanan Kasirajan1,Fawas Thonikadavath1, Rajeev K. Tiwari et al(2016) Cross pinning versus lateral pinning in type III supracondylar fracture a retrospective analysisInternational Journal of Research in Orthopaedics .2(3):138-142
20. Vito Pavone*, Maria Riccioli, Gianluca Testa, Ludovico Lucenti, Claudia de Cristo, GiuseppeCondorelli, surgical treatment of displaced supracondylar pediatric humerus fractures:Comparison of two pinning technique,Journal of functional morphology and kinesiology. 1:39–47
21. Yadagiri Surender Rao, Manoj Chakravorthy, Yadagiri et al (2015) A study of percutaneous k wire fixation in supracondylar fracture of humerus in children J Med Allied Sci .5(1):6-9
22. Khurram barlas, TajeshbagAet al (2005) Medial approach for fixation of displaced supracondylar fractures of the humerus in children ,Acta Orthop. Belg.71:149-153.
23. Alfonso Vaquero-Picado, et al (2018) Management of supracondylar fractures of the humerus in children journal of Efort Open Rev .3(10):526-540
24. Dr. Praveen.S.K1, Dr.Venkatachalam.K, Dr. Mani Arumugam1, , Dr. Prakash Karrun, et a l(2016) A prospective study of the functional and cosmetic outcome of supracondylar fracture of humerus in children treated by percutaneous pinning and orif with kirschner wires scholars Academic Journal of Biosciences.4(10B):934-951.

How to Cite this Article: Meena SK, Tiwari A, Bairwa DK, Sharma B | Supracondylar Humerus Fracturetreated With Closed Reduction and Percutaneous Cross Pinning Technique in Children | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 06-09.

(Article text HTML)      (Download PDF)

Calf Circumference in Clubfoot: The Effect of Patient Gender, Age, Laterality and Brace Duration

Volume 7 | Issue 1 | January-April 2021 | Page: 02-05 | Shobhit Gupta, Anil Agarwal, Mukesh Shanker

Authors: Shobhit Gupta MS Orth. [1], Anil Agarwal MS Orth. [1], Mukesh Shanker MS Orth. [1]

[1] Department of Orthopaedic, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.

Address of Correspondence
Dr. Shobhit Gupta,
Department of Pediatric Orthopedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
E-mail: drshobhitgupta@gmail.com

Abstract

Calf circumference is reduced in the leg affected by clubfoot. The effect of brace duration and whether calf circumference increases with age has not been studied in the Indian population. We conducted a cross sectional study on 156 children with idiopathic non-operated clubfeet treated by serial Ponseti casting method. The mean age was 32.7 months (range, 2-120 months). We found significant calf circumference difference in legs with clubfoot which increased with age. The duration of bracing did not significantly affect calf circumference.
Keywords: CTEV; Clubfeet; Calf circumference.

References 

1. Shimode K, Miyagi N, Majima T, Yasuda K, Minami A. Limb length and girth discrepancy of unilateral congenital clubfeet. J Pediatr Orthop B, 2005; 14: 280-4.
2. Maffulli N, Capasso G, Testa V, Borrelli L. Histochemistry of the triceps surae muscle in idiopathic congenital clubfoot. Foot Ankle, 1992; 13: 80-4.
3. Ippolito E, De Maio F, Mancini F, Bellini D, Orefice A. Leg muscle atrophy in idiopathic congenital clubfoot: is it primitive or acquired? J Child Orthop, 2009; 3: 171-8.
4. Ippolito E, Dragoni M, Antonicoli M, Farsetti P, Simonetti G, Masala S. An MRI volumetric study for leg muscles in congenital clubfoot. J Child Orthop, 2012; 6: 433-8.
5. Duce SL, D’Alessandro M, Du Y, Jagpal B, Gilbert FJ, Crichton L, et al. 3D MRI analysis of the lower legs of treated idiopathic congenital talipes equinovarus (clubfoot). PLoS One, 2013; 8: e54100.
6. Aronson J, Puskarich CL. Deformity and disability from treated clubfoot. J Pediatr Orthop, 1990; 10: 109-19.
7. Fulton Z, Briggs D, Silva S, Szalay EA. Calf circumference discrepancies in patients with unilateral clubfoot: Ponseti versus surgical release. J Pediatr Orthop, 2015; 35: 403-6.
8. Barker S, Downing M, Chesney D, Maffulli N. Assessment of calf volume in congenital talipes equinovarus by computer analysed digital photography. Surgeon, 2012; 10: 84-9.
9. Bohner Beke A, Leidecker E, Koch T, Sramo A, Kránicz J. Lower leg atrophy in congenital talipes equinovarus. Paediatria Croatica, 2014; 58: 176-83.
10. Gamble J, Batista E, Rinsky I. How small is the leg and foot in unilateral clubfoot. Orthopaedic Proceedings, 2012; 94-B: 34.
11. Bechtol CO, Mossman HW. Clubfoot; an embryological study of associated muscle abnormalities. J Bone Joint Surg Am, 1950; 32: 827-38.
12. Flinchum D. Pathological anatomy in talipes equinovarus. J Bone Joint Surg Am, 1953; 35: 111-4.
13. Gray K, Barnes E, Gibbons P, Little D, Burns J. Unilateral versus bilateral clubfoot: an analysis of severity and correlation. J Pediatr Orthop B, 2014; 23: 397-9.
14. Agarwal A, Agrawal N, Barik S, Gupta N. Are bilateral idiopathic clubfeet more severe than unilateral feet? A severity and treatment analysis. J Orthop Surg (Hong Kong), 2018; 26(2): 1 – 2.

How to Cite this Article: Gupta S, Agarwal A, Shanker M | Calf Circumference in Clubfoot: The Effect of Patient Gender, Age, Laterality and Brace Duration | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 02-05.

(Abstract)      (Full Text HTML)      (Download PDF)

January-April 2021

Editorial

Volume 7 | Issue 1 | January-April 2021 | Page: 01 | Jayant  S. Sampat

Authors: Jayant S. Sampath FRCSEd (Tr&Orth) [1]

[1] Department of Orthopaedics, Rainbow Children’s Hospital, Bangalore, Karnataka, India

Address of Correspondence
Dr. Jayanth S. Sampath,
Rainbow Children’s Hospital, Bangalore, Karnataka, India.
E-mail: editor.posi.ijpo@gmail.com

Dear Friends
On behalf of the Editorial Board, I am pleased to present the 1st issue of IJPO for the year 2021. As the world grapples with the pandemic, it has been difficult to find the right frame of mind for research and publication. We would like to record our gratitude to the contributors for the timely completion of the submission and review process.
Dr Maulin Shah has ably curated a symposium on Brachial Plexus Birth Palsy (BPBP) for this issue. The authors include doyens in the field of Brachial Plexus surgery in India. We thank the senior authors for generously sharing their immense experience in managing this difficult problem. The symposium will hopefully act as a practical reference for trainees and practising orthopaedic surgeons alike.
The original articles in this issue deal with familiar problems in Paediatric Orthopaedics namely clubfoot, chronic osteomyelitis and supracondylar fractures of the humerus. The authors describe their experience of managing these problems in a resource-limited setting whilst constantly striving to question current practice and suggest improvements.
We are still a fledgling organisation and need your support to reach greater heights. Please do consider IJPO, the official journal of Paediatric Orthopaedic Society of India when submitting your research work for peer-reviewed publication. The Editorial Board members are making special efforts to improve submitted manuscripts in terms of language and content.
Dr Jayanth S Sampath FRCSEd (Tr & Orth)
Editor.

 

How to Cite this Article:  Sampat JS  | Editorial | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 01.

(Article Text HTML)      (Download PDF)

Editorial

Volume 6 | Issue 2 | May-August 2020 | Page: 2-3 | Jayant S Sampath

Authors: Jayant S Sampath [1]

[1] Department of Orthopaedics, Rainbow Children’s Hospital, Bangalore, Karnataka, India

Address of Correspondence
Dr. Jayanth S Sampath,
Rainbow Children’s Hospital, Bangalore, Karnataka, India.
E-mail: editor.posi.ijpo@gmail.com,

Dear Friends,
This issue comes with the exciting news that Paediatric Orthopaedic Society of India (POSI) has recognised International Journal Of Paediatric Orthopaedics (IJPO) as its official journal.
IJPO was first published in 2015 with the aim of highlighting the treatment of paediatric orthopaedic conditions in the developing world setting. It is well recognised that existing reputable journals tend to focus on the latest technique or device; resources that may not be available to surgeons in emergent nations or affordable by their patients. Through symposia on practical management of supracondylar fractures, clubfoot and radial clubhand; IJPO has made an energetic beginning in tackling this issue. In addition to traditionally written papers, the journal invites authors to submit a summary of their work as a PowerPoint presentation or videos to supplement an article about a new technique.
Over the last 25 years, POSI has emerged as the leading academic body for paediatric orthopaedics in the Asia-Pacific region. Through its commitment to teaching and research, it has forged strong partnerships with sister societies throughout the world. Several ongoing academic collaborations, travelling fellowships, and joint research projects are destined to bear rich fruit in terms of new insights and understanding about the ongoing challenges in our day to day practice.
With the POSI collaboration, IJPO will be the favoured means of disseminating information to the paediatric orthopaedic community at large. Our call for expansion of the Editorial Board met with an enthusiastic response from POSI members. The new board represents a cross-section of members from across the country and different levels of seniority. With this newfound vigour, we endeavour to review your articles and provide a response quickly. Submissions that require further work will be provided mentorship from a senior POSI member. We aim to get you published without any compromise on quality or the peer-review process.
Our readers’ time will be better utilised if the latest trends and developments are summarised in the form of symposia on specific topics and review articles. IJPO will continue to serve this need with high-quality papers from experts in the field. We will also publish practice guidelines which are brought out from time to time by academic societies throughout the world.
IJPO and POSI remain committed to providing surgeons with easy and free access to the journal. Full-text articles will therefore continue to remain accessible through the IJPO and POSI websites. POSI members are provided the additional benefit of publication without any article processing charge.
We invite all POSI members and well-wishers to join us in this effort to create a stronger journal with a bright long-term future. With your help, we can reach our next milestone of achieving indexation in PubMed.
I look forward to receiving your comments and suggestions on editor.posi.ijpo@gmail.com

Yours Sincerely,
Dr Jayanth S Sampath
Editor

How to Cite this Article: Sampath J | Editorial | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 02-03.

(Abstract) (Full Text HTML)      (Download PDF)