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Management of Limb Deficiencies

Volume 10 | Issue 2 | May-August 2024 | Page: 48-54 | Sakti Prasad Das, Sankar Ganesh, Prateek Behera DOI- https://doi.org/10.13107/ijpo.2024.v10.i02.194 Submitted: 11/03/2024; Reviewed: 08/04/2024; Accepted: 25/06/2024; Published: 10/08/2024 Authors: Sakti Prasad Das MS(Ortho.), DNB(PMR) [1], Sankar Ganesh MPT [2], Prateek Behera MS(Ortho.), DNB(Ortho.) [3] [1] Medical Education & Training, DRIEMS University, Odisha, Tangi, Cuttack, […]

Management of Complex Foot Deformities in Children

Volume 10 | Issue 2 | May-August 2024 | Page: 34-39 | Sagar Umerjikar, Abhishek V. Mundargi, Koushik N. Subramanyam DOI- https://doi.org/10.13107/ijpo.2024.v10.i02.190 Submitted: 25/05/2024; Reviewed: 24/06/2024; Accepted: 21/07/2024; Published: 10/08/2024 Authors: Sagar Umerjikar MS Ortho [1], Abhishek V. Mundargi MS Ortho [1], Koushik N. Subramanyam MS Ortho [1] [1] Department of Orthopaedics, Sri Sathya Sai […]

Management of Limb Deficiencies

Management of Complex Foot Deformities in Children

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Management of Limb Deficiencies

Volume 10 | Issue 2 | May-August 2024 | Page: 48-54 | Sakti Prasad Das, Sankar Ganesh, Prateek Behera

DOI- https://doi.org/10.13107/ijpo.2024.v10.i02.194

Submitted: 11/03/2024; Reviewed: 08/04/2024; Accepted: 25/06/2024; Published: 10/08/2024

Authors: Sakti Prasad Das MS(Ortho.), DNB(PMR) [1], Sankar Ganesh MPT [2], Prateek Behera MS(Ortho.), DNB(Ortho.) [3]

[1] Medical Education & Training, DRIEMS University, Odisha, Tangi, Cuttack, Odisha, India.
[2] Department of Physiotherapy, Composite Regional Centre, Lucknow, Uttar Pradesh, India.
[3] Department of Orthopaedics, AIIMS Bhopal, Madhya Pradesh, India.

Address of Correspondence

Dr. Sakti Prasad Das,
Director, Medical Education & Training, DRIEMS University, Odisha, Tangi, Cuttack, Odisha, India.
E-mail: sakti2663@yahoo.com

Abstract

Limb deficiency disorders encompass a wide variety of congenital anomalies that have a significant underdevelopment or even complete absence of bones in the limbs. Treatment of these conditions must be holistic with the child at the centre. This article provides a review of the current understanding of the management of such conditions. Surgical treatment offers a practical and effective solution for treating many variants of congenital limb abnormalities. Although novel surgical treatments may expand the range of disorders that can be treated, it is crucial for both the surgeon and the family to be aware of the careful prognosis associated with the methods used. Additionally, the importance of an amputation as an option should always be kept under consideration.
Keywords: Amputation, Congenital Abnormalities, Deformity correction, Limb reconstruction, Pediatric skeletal deficiencies, Skeletal dysplasia

References

1. WHO. Congenital disorders. Geneva: WHO, 2023. Available: https://www.who.int/news-room/fact-sheets/detail/birth-defects
2. Moges N, Anley DT, Zemene MA, Adella GA, Solomon Y, Bantie B, et al. Congenital anomalies and risk factors in Africa: a systematic review and meta-analysis. BMJ paediatrics open, 2023;7(1), e002022. https://doi.org/10.1136/bmjpo-2023-002022
3. WHO. International statistical classification of diseases and related health problems (ICD)-11. Geneva WHO. 2023. Available: https://www.who.int/classifications/classification-of-diseases
4. Epps CH Jr. Proximal femoral focal deficiency. J Bone Joint Surg Am 1983; 65: 867–70.
5. Kakarla S. Proximal femoral focal deficiency (PFFD) imaging spectrum. J Med Sci Res. 2015;3(2):90–93. doi: 10.17727/JMSR.2015/3-018
6. Paley D, Guardo F. Lengthening reconstruction surgery for congenital deficiency. In: Kocaoglu M, Tsuchiya H, Eralp L, editors. Advanced techniques in limb reconstruction surgery. 2014. pp. 245–298.
7. Gupta SK, Alassaf N, Harrop AR, Kiefer GN. Principles of rotationplasty. J Am Acad Orthop Surg. 2012;20:657–667. doi: 10.5435/JAAOS-20-10-657
8. Ackman J, Altiok H, Flanagan A, Peer M, Graf A, Krzak J, et al. Long-term follow-up of Van Nes rotationplasty in patients with congenital proximal focal femoral deficiency. Bone Joint J. 2013;95-B(2):192–198. doi: 10.1302/0301-620X.95B2.30853
9. Jones D, Barnes J, Lloyd-Roberts GC. Congenital aplasia and dysplasia of the tibia with intact fibula. Classification and management. J Bone Joint Surg Br. 1978;60(1):31-39. doi:10.1302/0301-620X.60B1.627576
10. Kalamchi A., Dawe R.W. Congenital deficiency of the tibia. J. Bone Jt. Surg. Br. 1985;67:581–584. doi: 10.1302/0301-620X.67B4.4030854
11. Weber M. New classification and score for tibia hemimelia. J Child Orthop. 2008;2:169–175.
12. Fernandez-Palazzi F, Bendahan J, Rivas S. Congenital deficiency of the tibia: a report on 22 cases. J Pediatr Orthop B. 1998;7:298–302.
13. Epps C.H., Jr., Schneider P. Treatment of hemimelias of the lower extremity. Long–term results. J. Bone Jt. Surg. Am. Vol. 1989;71:273–277. doi: 10.2106/00004623-198971020-00015
14. Putti V. The treatment of congenital absence of the tibia or fibula. Chir. Org. Mov. 1929;7:513.
15. Paley D. Surgical reconstruction for fibular hemimelia. J. Child. Orthop. 2016;10:557–583. doi: 10.1007/s11832-016-0790-0
16. Paley D., Robbins C. Fibular hemimelia Paley type 3. In: Rozbruch S.R., Hamdy R., editors. Limb Lengthening and Reconstruction Surgery Case Atlas. 1st ed. Springer International Publishing; Cham, Switzerland: 2015. pp. 1–8.
17. Johnson CE, Haideri NF. Comparison of functional outcome in fibular deficiency treated by limb salvage versus Syme’s amputation. In: Herring JA, Birch JG, eds. The Child With a Limb Deficiency. Rosemont: American Academy of Orthopaedic Surgeons; 1998: 173–177.
18. Herzenberg J., Shabtai L, Standard SC. Fibular hemimelia: Principles and techniques of management. In: Sabharwal S., editor. Pediatric Lower Limb Deformities, Principles and Techniques of Management. 1st ed. Springer International Publishing; Cham, Switzerland: 2016. pp. 427–454.
19. Birch JG, Lincoln TL, Mack PW, et al. Congenital fibular deficiency: a review of thirty years’ experience at one institution and a proposed classification system based on clinical deformity. J Bone Joint Surg Am. 2011;93:1144–1151.
20. Ali S, Kaplan S, Kaufman T, Fenerty S, Kozin S, Zlotolow DA. Madelung deformity and Madelung-type deformities: a review of the clinical and radiological characteristics. Pediatr Radiol. 2015;45(12):1856-1863. doi:10.1007/s00247-015-3390-0
21. Nielsen JB. Madelung’s deformity. A follow-up study of 26 cases and a review of the literature. Acta Orthop Scand. 1977;48(4):379-384. doi:10.3109/17453677708992012
22. Farr S, Martinez-Alvarez S, Little KJ et al (2021) The prevalence of Vickers’ ligament in Madelung’s deformity: a retrospective multicentre study of 75 surgical cases. J Hand Surg Eur. https://doi. org/ 10. 1177/ 17531 93420 981522
23. Vickers D, Nielsen G. Madelung deformity: surgical prophylaxis (physiolysis) during the late growth period by resection of the dyschondrosteosis lesion. J Hand Surg Br. 1992;17(4):401-407.
24. Laffosse JM, Abid A, Accadbled F, Knör G, de Gauzy JS, Cahuzac JP. Surgical correction of Madelung’s deformity by combined corrective radioulnar osteotomy: 14 cases with four-year minimum follow-up. IntOrthop. 2009; 33: 1655-1661.
25. Steinman S, Oishi S, Mills J, Bush P, Wheeler L, Ezaki M. Volar ligament release and distal radial dome osteotomy for the correction of Madelung deformity: long-term follow-up. J Bone Joint Surg Am. 2013;95(13):1198-1204. doi:10.2106/JBJS.L.00714
26. Colen DL, Lin IC, Levin LS, Chang B. Radial longitudinal deficiency: recent developments, controversies, and an evidence-based guide to treatment. J Hand Surg Am. 2017 Jul;42(7):546-563. https://doi.org/10.1016/j.jhsa.2017.04.012
27. Bednar MS, James MA, Light TR. Congenital longitudinal deficiency. J Hand Surg Am. 2009 Nov;34(9):1739-1747. https://doi.org/10.1016/j.jhsa.2009.09.002
28. Stutz C, Oishi S. Radial longitudinal deficiency: radius hypoplasia. In: Laub Jr DR, ed. Congenital Anomalies of the Upper Extremity. New York: Springer; 2015:85-94.
29. Takagi T, Seki A, Mochida J, Takayama S. Bone lengthening of the radius with temporary external fixation of the wrist for mild radial club hand. J Plast Reconstr Aesthetic Surg. 2014;67:1688e1693. https://doi.org/10.1016/ j.bjps.2019.05.044
30. Buck-Gramcko D. Radialization as a new treatment for radial club hand. J. Hand Surg. Am. 1985;10(6 Pt 2):964–968. doi: 10.1016/S0363-5023(85)80013-7
31. Wall LB, Ezaki M, Oishi SN. Management of congenital radial longitudinal deficiency: controversies and current concepts. Plast Reconstr Surg. 2013 Jul;132(1):122-128.
32. Cole RJ, Manske PR .Classification of ulnar deficiency according to the thumb and first web.. J Hand Surg Am. 1997;22:479–488.

How to Cite this Article: Das SP, Ganesh S, Behera P | Management of Limb Deficiencies | International Journal of Paediatric Orthopaedics | May-August 2024; 10(2): 48-54. https://doi.org/10.13107/ijpo.2024.v10.i02.194

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Management of Complex Foot Deformities in Children

Volume 10 | Issue 2 | May-August 2024 | Page: 34-39 | Sagar Umerjikar, Abhishek V. Mundargi, Koushik N. Subramanyam

DOI- https://doi.org/10.13107/ijpo.2024.v10.i02.190

Submitted: 25/05/2024; Reviewed: 24/06/2024; Accepted: 21/07/2024; Published: 10/08/2024

Authors: Sagar Umerjikar MS Ortho [1], Abhishek V. Mundargi MS Ortho [1], Koushik N. Subramanyam MS Ortho [1]

[1] Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthigram, Puttaparthi, Andhra Pradesh, India.

Address of Correspondence

Dr. Koushik Narayan Subramanyam ,
Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthigram, Puttaparthi, Andhra Pradesh, India.
E-mail: koushik.n@sssihms.org.in

Abstract

Aim: The aim of this article is to understand the intricacies of various complex foot deformities in children and non-operative and operative strategies in managing them by reviewing data from published literature.
Methods: A review of information pertaining to complex foot deformities in children was assimilated for holistic understanding of the condition along with their management from various sources from PubMed and Google Scholar.
Conclusion: Treatment of pediatric foot and ankle deformities is complex and must be individualized. The inter-individual phenotypic variability demands a personalized planning of each foot to be operated. Factors to consider are age at presentation, primary pathology causing the deformity and the underlying complex pathoanatomy. Treatment must also assess the possibility of relapse of the deformity and measures must be incorporated to prevent the same.

Keywords:

References

1. Kocaoğlu M, Eralp L, Atalar AC, Bilen FE. Correction of complex foot deformities using the Ilizarov external fixator. J Foot Ankle Surg. 2002 Jan-Feb;41(1):30-9. doi: 10.1016/s1067-2516(02)80007-2. PMID: 11858604.
2. Dhar S. Ilizarov external fixation in the correction of severe pediatric foot and ankle deformities. Foot Ankle Clin. 2010 Jun;15(2):265-85. doi: 10.1016/j.fcl.2010.03.001. PMID: 20534355.
3. Riganti S, Coppa V, Nasto LA, Di Stadio M, Calevo MG, Gigante AP, Boero S. Treatment of complex foot deformities with hexapod external fixator in growing children and young adult patients. Foot Ankle Surg. 2019 Oct;25(5):623-629. doi: 10.1016/j.fas.2018.07.001. Epub 2018 Jul 9. PMID: 30321938.
4. Reeves CL, Shane AM, Zappasodi F, Payne T. Surgical Correction of Rigid Equinovarus Contracture Utilizing Extensive Soft Tissue Release. Clin Podiatr Med Surg. 2016 Jan;33(1):139-52. doi: 10.1016/j.cpm.2015.06.009. Epub 2015 Aug 20. PMID: 26590731.
5. Vlachou M, Dimitriadis D. Split tendon transfers for the correction of spastic varus foot deformity: a case series study. J Foot Ankle Res. 2010 Dec 14;3:28. doi: 10.1186/1757-1146-3-28. PMID: 21156075; PMCID: PMC3016343.
6. Elgeidi A, Abulsaad M. Combined double tarsal wedge osteotomy and transcuneiform osteotomy for correction of resistant clubfoot deformity (the “bean-shaped” foot). J Child Orthop. 2014 Oct;8(5):399-404. doi: 10.1007/s11832-014-0613-0. Epub 2014 Oct 4. PMID: 25280469; PMCID: PMC4391053.
7. Rampal V, Giuliano F. Forefoot malformations, deformities and other congenital defects in children. Orthop Traumatol Surg Res. 2020 Feb;106(1S):S115-S123. doi: 10.1016/j.otsr.2019.03.021. Epub 2019 Oct 21. PMID: 31648997.
8. Moreira, A., Benjamin Ravetti, L., Carrapeiro Prina, D. et al. Anterior tibial tendon transfer in idiopathic clubfoot: pull-out vs. other fixations – a systematic review. BMC Musculoskelet Disord 25, 638 (2024). https://doi.org/10.1186/s12891-024-07621-9
9. Farsetti P, Dragoni M, Ippolito E. Tibiofibular torsion in congenital clubfoot. J Pediatr Orthop B. 2012 Jan;21(1):47-51. doi: 10.1097/BPB.0b013e32834d4dc3. PMID: 22027706.
10. Walton DM, Liu RW, Farrow LD, Thompson GH. Proximal tibial derotation osteotomy for torsion of the tibia: a review of 43 cases. J Child Orthop. 2012 Mar;6(1):81-5. doi: 10.1007/s11832-012-0384-4. Epub 2012 Jan 31. PMID: 23448753; PMCID: PMC3303016.
11. Alkar F, Louahem D, Bonnet F, Patte K, Delpont M, Cottalorda J. Long-term Results After Extensive Soft Tissue Release in Very Severe Congenital Clubfeet. J Pediatr Orthop. 2017 Oct/Nov;37(7):500-503. doi: 10.1097/BPO.0000000000000703. PMID: 26633817.
12. Eidelman M, Kotlarsky P, Herzenberg JE. Treatment of relapsed, residual and neglected clubfoot: adjunctive surgery. J Child Orthop. 2019 Jun 1;13(3):293-303. doi: 10.1302/1863-2548.13.190079. PMID: 31312269; PMCID: PMC6598039.
13. Kirienko A, Villa A, Calhoun JH Ilizarov technique for complex foot and ankle deformities. Boca Raton: CRC Press, 2003.
14. van Bosse HJP. Challenging clubfeet: the arthrogrypotic clubfoot and the complex clubfoot. J Child Orthop. 2019 Jun 1;13(3):271-281. doi: 10.1302/1863-2548.13.190072. PMID: 31312267; PMCID: PMC6598040.
15. Conklin MJ, Kishan S, Nanayakkara CB, Rosenfeld SR. Orthopedic guidelines for the care of people with spina bifida. J Pediatr Rehabil Med. 2020;13(4):629-635. doi: 10.3233/PRM-200750. PMID: 33252095; PMCID: PMC7838956.
16. Horsch A, Petzinger L, Ghandour M, Putz C, Renkawitz T, Götze M. Defining Equinus Foot in Cerebral Palsy. Children (Basel). 2022 Jun 25;9(7):956. doi: 10.3390/children9070956. PMID: 35883940; PMCID: PMC9320304.
17. Kadhim M, Holmes L Jr, Church C, Henley J, Miller F. Pes planovalgus deformity surgical correction in ambulatory children with cerebral palsy. J Child Orthop. 2012 Jul;6(3):217-27. doi: 10.1007/s11832-012-0413-3. Epub 2012 Jun 20. PMID: 23814622; PMCID: PMC3400002.
18. Hochstetter-Owen J, Stott S, Williams SA. The efficacy of split tibial tendon transfers on functional gait outcomes for children and youth with cerebral palsy and spastic equinovarus foot deformities. Bone Jt Open. 2023 May 1;4(5):283-298. doi: 10.1302/2633-1462.45.BJO-2023-0005.R1. PMID: 37121581; PMCID: PMC10149292.
19. Wirth T. Congenital Vertical Talus. Foot Ankle Clin. 2021 Dec;26(4):903-913. doi: 10.1016/j.fcl.2021.08.002. Epub 2021 Oct 7. PMID: 34752243.
20. Altaf KA, Shah SBS, Ahmad S, Mumtaz U, Mantoo SA. Results of JESS (Joshi’s External Stabilizing System) in Relapsed, Neglected and Neurogenic Clubfoot in an Age Group of 2-10 Years. Ortop Traumatol Rehabil. 2020 Apr 30;22(2):121-129. doi: 10.5604/01.3001.0014.1170. PMID: 32468991.

How to Cite this Article: Umerjikar S, Mundargi AV, Subramanyam KN | Management of Complex Foot Deformities in Children | International Journal of Paediatric Orthopaedics | May-August 2024; 10(2): 34-39.

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Management of Limb Deficiencies

Management of Complex Foot Deformities in Children

Management of Limb Deficiencies

Management of Complex Foot Deformities in Children

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Management of Limb Deficiencies

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Management of Complex Foot Deformities in Children

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