Comparison of two surgical approaches in clubfoot : single posteromedial release versus combined posteromedial and lateral releases

الملخص EN

This comparative prospective study was conducted to assess surgical outcome and post-operative 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.