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Year : 2006  |  Volume : 40  |  Issue : 3  |  Page : 191-195

Postero-medial release in clubfoot - A retrospective study of causes of failures

GT Sheth Orthopedic Hospital & Research Institute, Rajkot, India

Correspondence Address:
A V Sanghvi
‘AVSAR’, 4/4, Patel colony, Jamnagar- 361008, Gujarat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5413.34492

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Introduction : Postero-medial release is the most common surgical procedure used to correct the deformity of clubfoot. It has been seen that despite a good correction immediately following the surgery, the long-term results are not satisfactory. Material and methods : A retrospective study was carried out in a total number 52 clubfeet in 36 patients treated by postero­medial release to assess the causes of failures. The mean duration after surgery was 5.1±1.2 years, mean age at operation was 1.1±0.5 years and mean age of patient at final follow up was 6.9±2.1 years. The results were plotted and compared with different variables. Results : The results were successful in 36 and failure in 16 patients. A significantly high failure rate of 80% was found when postero-medial release was done after 3 years of age as a sole procedure as compared to 25.5% only if age was less than 3 years (p<0.05). The patient compliance to follow bracing protocol showed significantly high failure rate of 52.4% in non-compliant patients versus 16.1% in compliant patients (p<0.05). A significantly high failure rate was also seen when bracing was not continued beyond 3 years after surgery (p<0.05). Neurological clubfoot had a significantly high failure rate (80%) compared to idiopathic clubfoot (25.5%) (p<0.05). A significantly high failure rate was also noted when infection and skin necrosis lead to skin grafting or flap coverage as compared to those healed with dressings alone (p<0.05). Conclusion : Postero-medial release achieves best results in patients of less than 3 years of age and patients with compliance for bracing for at least up to 3-4 years following surgery and idiopathic clubfoot. Infection in clubfoot does not increase the failure rate unless it is severe enough to require plastic coverage. Any deviations from the above significantly increase the chances of failure of the procedure and hence can be labeled as the causes of failures of postero-medial release.

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