Print ISSN: 1683-3589

Online ISSN: 2409-501X

Keywords : COMPARISON OF TWO SURGICAL APPROACHES IN CLUBFOOT


COMPARISON OF TWO SURGICAL APPROACHES IN CLUBFOOT: SINGLE POSTEROMEDIAL RELEASE VERSUS COMBINED POSTEROMEDIAL AND LATERAL RELEASES

Alaa Abdulemmam Barrak; Ouday Falih Al-Ali

Basrah Journal of Surgery, 2010, Volume 16, Issue 2, Pages 38-45
DOI: 10.33762/bsurg.2010.55440

This comparative prospective study was conducted to assess surgical outcome and postoperative
complications in 70 children with 115 idiopathic clubfeet treated at Basrah General
Hospital. Children up to age of 5 years were included. There were 49 males and 21 females.
Male to female ratio was 2.3:1. The deformity was bilateral in 61.4% and unilateral in 38.6% of
cases. The indications for surgery were failure of early conservative treatment and late patient
presentation beyond 6 months of age. Patients were placed into two groups; group A in whom a
standard posteromedial soft tissue release through single incision including 58 feet (19
moderate, 28 severe, and 11 very severe), whereas in group B, combined posteromedial and
lateral releases through two separate incisions in 57 feet (19 moderate, 28 severe, and 10 very
severe). Analysis of data reveals that combined release is superior to single release in the rates
of operative wound breakdown and more important in term of correction of initial preoperative
clubfoot deformity for which the surgery was performed. Postoperative skin necrosis occurred in
8.8% of combined release feet compared to 17.2% in single posteromedial release feet. With
combined release 87.7% of feet obtained satisfactory deformity correction outcome in contrast
to only 63.8% in single release feet. The most common single residual deformity reported in this
study following surgical correction whether by single posteromedial release (13.8%) or by
combined release (12.3%) was forefoot adduction. The risk of wound infection was
approximately the same for both procedures 8.6% in single release, and 8.8% in combined
release.
The study showed that the proportion of satisfactory deformity correction results decreases as
the patient age at operation increases, particularly if single posteromedial release alone was
performed. With single release a 100% satisfactory deformity correction outcome will be
obtained only if surgery was performed during the first 6 months of life, beyond which this rate
had dropped to 63.6% when operation was delayed to the age of 7-12 months, and to 25% at
1-3 years of age. After 3 years of age single posteromedial release alone did not yield any
satisfactory results. On the other hand a100% satisfactory results were obtained in all feet
treated with combined release during the whole period of the first 3 years of life, after which the
rate of satisfactory results decreased to 50%. The study highly recommends the use of
combined posteromedial and lateral release through two separate incisions when operating on
clubfeet above the age of 6 months. This is a very valuable procedure with high success rate
both in correcting the initial deformity and minimizing the rates of surgical wound breakdown.