Residual Clubfoot - Correction By Controlled Differential Fractional Distraction

Introduction; Treatment of club foot is still a clinical challenge. The literature on clubfoot as a general rule, that of unvarying success. The increased failure rates among conservative management has lead to various surgical interventions. A recent study of clubfoot surgeries have come up with a high proportion of unsatisfactory results. The work of Illizarov showed encouraging results without the dreaded complication of infections. He believed that controlled mechanical stress lead to regeneration of soft tissues including skin, muscle, tendon, nerve. Aims And Objectives; In this study, we aim to assess the result of residual clubfoot correction using Joshi’s external stabilizing system at Jubilee Mission Medical College Hospital, Thrissur, Kerala. METHODOLOGY, we have analysed 25 children with clubfoot deformity who had undergone correction by differential fractional distraction in Jubilee Mission Medical College in the year 2008 to 2010.They were followed up for two years ,bi monthly. All had idiopathic club foot. There 15 male child and 10 female child aged between 6 to 10 years. All the patients had prior soft tissue releases at different age group. All these patients had discontinued their treatment for various reasons. We did Dr. B.B Joshi external frame on all these children. Pre operatively they were assessed with Carrolls criteria, radiological assessment was also done. Post operative period for correction of deformity varied from 4 weeks to 7 weeks. Once correction is obtained then the apparatus is locked in that position for 6 weeks. The results were analysed with Functional Rating System advocated by Lehman. Results And Observations; 57.14 % had excellent functional outcome,17.8% had good outcome, 17.8% had fair outcome. Only 7.14 % had poor outcome. 17.86 % obtained dorsiflexion beyond 0 degree, 75% obtained neutral foot. Adduction deformity of fore foot was corrected in 100% of the cases. The average talocalcaneal angle pre and post operative was 29.8 and 55 degree respectively.. There were only minor complications in patients. Conclusion; External fixation is a good method in management of residual deformity in congenital talipus equino varus. Cosmetic and functional results are satisfactory. Radiological correction is comparable with other methods. Ankle dorsiflexion is better when compared to other soft tissue procedures.