The first experience of using customized fixators in the surgical treatment of abducto-plano-valgus foot deformity in children

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Abstract

Background. Abducto-plano-valgus foot deformity is one of the most common diseases affecting children and teens. Recently, various methods of surgical treatment have been proposed for the same. However, despite the availability of various operational methods, there are several contradictions in the feasibility and success of a particular operation.

Aim. To improve the technique of Evans Calcaneal osteotomy through the use of customized heel bone fixators.

Materials and methods. A total of 30 patients (42 feet) aged 9–15 years with abducto-plano-valgus foot deformity were included. We undertook clinical examination, X-ray, computed tomography, and experimental researches. The surgical treatment consisted of Evans Calcaneal osteotomy, with the use of the standard method of fixation in group 1 (n = 33 feet) and the use of a customized fixator in group 2 (n = 9 feet).

Results. The improved technique of Evans Calcaneal osteotomy using a special customized fixator allowed making the necessary correction in 100% of cases. The period of restoration of the heel bone integrity was reduced by an average of 30% (p < 0.05). The period of restoration of the support became faster by almost 45% (p < 0.05).

Conclusion. The use of a special customized fixator for Evans Calcaneal osteotomy could significantly improve the outcomes and shorted the treatment time for children with abducto-plano-valgus foot deformity.

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About the authors

Oleg V. Kozhevnikov

N.N. Priorov Central Research Institute of Traumatology and Orthopedics

Email: 10otdcito@mail.ru
ORCID iD: 0000-0003-3929-6294

MD, PhD, D.Sc., Head of the 10th Traumatological and Orthopedic Children’s Department

Russian Federation, Moscow

Inna V. Gribova

N.N. Priorov Central Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: grinna@bk.ru
ORCID iD: 0000-0001-7323-0681

MD, PhD, Senior Researcher of the 10th Traumatological and Orthopedic Children’s Department

Russian Federation, Moscow

Svetlana E. Kralina

N.N. Priorov Central Research Institute of Traumatology and Orthopedics

Email: 10otdcito@mail.ru
ORCID iD: 0000-0001-6956-6801

MD, PhD, Senior Researcher of the 10th Traumatological and Orthopedic Children’s Department

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Mechanical and strength tests of the H-shaped reconstructive plate. a, Native calcaneal bone after wedging osteotomy and fixator installation; b, the testing machine, LFM-50kN; c, registration of the test schedule

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3. Fig. 2. Formation of wedge-shaped diastasis. 1, Calcaneal bone; 2, calcaneocubital joint; 3, wedge-shaped diastasis; S, the width of the base of diastasis; А, the angle between the surfaces of the separated bone fragments

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4. Fig. 3. Stages of the Evans surgery with the use of a customized H-shaped reconstructive plate. a, Lateral access to the calcaneus body with lengthening of the tendon of the peroneus brevis; b, osteotomy of the calcaneus; c, installation of the H-shaped plate; d, filling the bone defect with chips; e, intraoperative radiogram, lateral view; f, intraoperative radiogram, frontal view

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5. Fig. 4. Patient K, aged 15 years, with abducto-plano-valgus deformity of the right foot. a, b, Appearance of the foot before surgery (calcaneal valgus, flattening of the longitudinal arch); c, d, preoperative radiograms; e, f, radiograms of the right foot after lateral osteotomy of the heel bone with fixation with a customized H-shaped reconstructive plate; g, h, appearance of the foot 1 year after surgery (the calcaneus is along the midline, the longitudinal arch is visualized); i, j, radiograms of the right foot 1 year after the surgery

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Copyright (c) 2020 Kozhevnikov O.V., Gribova I.V., Kralina S.E.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
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