Extraosseous Blood Supply to the Neonatal Femoral Head

Abstract

The anatomic abnormalities and the effects of serial release of soft tissue are described in seven stillborn fetal clubfeet. The essential anatomic abnormality is a dislocation of the talocalcaneonavicular joint, with dysplastic changes in the talus and less severe changes in the adjacent bones. By gradually releasing the structures contributing to the tether, the amount of correction of deformity was equated to three current types of surgical procedures: posterior release, posteromedial release, and a combined full subtalar, midtarsal, and posteromedial release. In severe deformities, only by using the third most extensive procedure is the navicular fully reduced onto the talar head, and the calcaneous rotated laterally and posteriorly with the cuboid to open the "scissors" of the hindfoot. The talonavicular joint, the calcaneocuboid and subtalar joints, and the lateral calcaneofibular ligament must be released to achieve this end. This experimental technique encompasses the release of many structures. With varying severity of deformity, a less extensive dissection may often be sufficient to achieve correction.