Year : 2013  |  Volume : 6  |  Issue : 3  |  Page : 274-280

A clinical study of ligamentoaxis using an external fixator, modified frame in the management of a neglected, relapsed, resistant older congenital Talipes Equino varus child

1 Department of Orthopaedics, Shri Annasaheb Shinde Mhaishalkar Charitable Trust and Post Graduate Institute of Orthopaedics, Sangli, India
2 Department of Orthopedics, Padmashree Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India

Correspondence Address:
Ajit Shinde
Mhaishalkar Shinde Hospital, Civil Hospital Chowk, Dr. Abmedkar Road, Sangli, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-2870.114661

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Background: In an older, relapsed, recurrent, resistant Congenital Talipes Equino Varus (CTEV) child with previous surgical scar, soft tissue release alone is often not sufficient for full correction, particularly at above 2 years of age. Here controlled, fractional differential distraction with Joshi's external stabilization system is a useful option to correct all the deformities. It is a well-established modality but with complication rate of 30%, mainly related to pin loosening and infection leading to instability of frame. We aimed to study a method to increase stability of frame to reduce incidence of pin loosening, infection and to evaluate clinical and functional outcome of the modality along with modification. Materials and Methods: 117 children underwent Joshi's external stabilization system procedure. The principle of correction applied in this study was fractional distraction. Patients were evaluated by Catteral and Simons criteria. Results: Excellent results were obtained in 68.50% of cases, good results in 23.90%, and poor results in 7.60% of the cases. The complication rate reduced to 3% pin tract infections, which eventually healed with outpatient treatment. Conclusion: Fractional distraction method by using Joshi's External Stabilization System is an easy, simple, less invasive method, which corrects all the deformities in resistant, neglected, and relapsed cases of CTEV and modification of the frame we used proved to be beneficial. Teaching and awareness of parents regarding distraction schedule, stability of frame postoperative importance of wearing of corrected footwear for long period are important.

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