Mistakes and complications in the surgical treatment of ambulatory equino planovalgus foot deformities in patients with cerebral palsy using extra-articular subtalar arthrodesis

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Abstract


Aim.

To evaluate the results of a modified technique for extra-articular arthrodesis of the subtalar joint for patients with cerebral palsy with an ambulatory form of equine-planovalgus deformity of the foot. The mistakes and complications that occurred during treatment with this technique are discussed.

Materials and methods.

Between 2005 and 2015, this surgical method for performing arthrodesis of the subtalar joint, was performed on 544 patients (989 feet) between 4 and 15 years old. Correction of equinus contracture was performed using Achilles tendon plasty or dissection of the tendon of the gastrocnemius muscle. Abnormal muscle tone was reduced either by administering Dysport® in the calf muscle or by selective neurotomy of the tibial nerve.

Results.

Good results were achieved for 72% of cases, satisfactory for 23% of cases, and unsatisfactory for 5% of cases. Unsatisfactory results of treatment were associated with overvaluation of the degree of mobility of the deformity and with a number of technical and tactical mistakes.

Conclusion.

This analysis of mistakes and complications of extra-articular arthrodesis of the subtalar joint will allow surgeons to avoid these issues in the future and improve the quality of treatment for similar patients.


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About the authors

Valery V Umnov

The Turner Scientific and Research Institute for Children’s Orthopedics

Author for correspondence.
Email: umnovvv@gmail.com

Russian Federation MD, PhD, professor, head of the department of infantile cerebral palsy. The Turner Scientific and Research Institute for Children’s Orthopedics.

Dmitry V Umnov

The Turner Scientific and Research Institute for Children’s Orthopedics

Email: dmitry.umnov@gmail.com

Russian Federation MD, PhD, research associate of the department of infantile cerebral palsy. The Turner Scientific and Research Institute for Children’s Orthopedics

References

  1. Bennet GC, Rang M, Jones D. Varus and valgus deformities of the foot in cerebral palsy. Developmental Medicine & Child Neurology. 2008;24(5):499-503. doi: 10.1111/j.1469-8749.1982.tb13656.x.
  2. Патент РФ на изобретение № 2372041/10.11.09. Бюл. № 31. Умнов В.В., Умнов Д.В. Способ лечения плоско-вальгусной деформации стопы у детей. [Patent RUS 2372041/10.11.09. Byul. № 31, Umnov VV, Umnov DV. Sposob lecheniya plosco-valgusnoy deformatsii stopi u detei. (In Russ).]
  3. Grice DS. An extra-articular arthrodesis ofthe subastragal joint for correction of paralytic flatfeet in children. J Bone J Surg Am. 1952;34:927-956.

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Copyright (c) 2016 Umnov V.V., Umnov D.V.

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