Importance of operative intervention in the treatment of clubfoot associated with congenital constriction Band syndrome

Abstract

Background: Congenital talipes equino-varus is the most common congenital orthopaedic condition requiring intensive treatment. It has been associated with neuromuscular diseases and syndromes and specifically, CTEV associated with congenital constriction band syndrome forms the resistant variety of CTEV. This most often requires operative intervention in the form of postero-medial soft tissue release, JESS Fixator and Illizarov fixators. Material and Methods: 10 patients of less than 2 years with resistant CTEV associated with congenital constriction band syndrome, who required operative intervention were operated with JESS fixator at Govt. Medical College and Rajindra hospital, Patiala between august 2017 to august 2019. Following the correction, the assembly was held in the static position for the same period to allow for soft tissue maturation in the elongation position. Removal of the whole assembly was followed by well moulded above knee plaster cast in maximum correction for the same period followed by CTEV corrective shoes for 5 years to maintain correction and prevent recurrence. Results: Patients were evaluated using functional rating system for clubfoot, hospital for joint diseases, orthopaedic institute as excellent, good, fair and poor. 7 feet (70%) were graded as excellent, 2 feet (20%) were graded as good, 1 feet (10%) as fair and 1 feet (10%) as poor. In this study, 1 feet (10%) had persistent oedema, 2 feet (20%) had flexion contractures of toes, 1 feet (10%) had tibial loosening of pin, 1 feet (10%) had rocker bottom foot and none of the feet had skin necrosis. Conclusion: Congenital talipes equino-varus in a child of congenital constriction band syndrome forms the resistant variety of of CTEV, in which operative treatment is the mainstay of treatment. Joshi’s external stabilisation system has proved to be an good treatment option in such cases.