Joshi's External Stabilization System Research Articles

The management of metacarpal and phalangeal fractures of hand by K-wires and Joshi’s external stabilization system

Background: Hand injuries are quite common and affect 15% of people who go to the emergency room. The metacarpals and phalanges are the two bones that fracture most frequently, with a prevalence of between 10 and 15%. Use of K-wires with an external fixation system, such as Joshi's external stabilization system (JESS), is optional. According to the ligamentotaxis theory, JESS functions. Aim was to evaluate the clinical and radiological outcome of metacarpal and phalangeal fractures using k wires and jess. Methods: This prospective study was conducted in post graduate department of orthopaedics SKIMS medical college Bemina, on 40 patients with metacarpal and phalangeal fractures managed by Kirschner wires (K-wires) and JESS. The collected data was analyzed with the help of statistical package for social science (SPSS), version 21 Results: In present study the most of the study subjects were in the age group of 28-37 years (40%), there was male predominance with the male to female ratio 2.5:1, majority of the study subjects were labourer (38%), right side was involved most commonly (62%), the major cause of fracture was road traffic accident (58%) and most (96%) of the study subjects were operated within 24 hours of the injury. Conclusions: The study concluded that augmentation of JESS over K-wires provides a stable skeletal environment with early tissue healing and immediate active and passive mobilization of the uninjured adjacent joints and also provides rotational stability as the majority of the study subjects achieved excellent functional outcome.

Comparison of Joshi's external stabilization system and Kirschner wire fixation technique for extra-articular metacarpal fractures

Hand fractures, especially metacarpals and phalanges, account for 15% of emergency department admissions. Metacarpal fractures can be treated using various algorithms. Hand fractures have been treated with K wire fixation, micro plates, and external fixator application devices. A successful functional outcome requires surgical intervention with good fixation principles and a rigid system that allows early mobilization. JESS is a simple, lightweight fixation that can be used with splints or converted to dynamic mobilization units. In open fractures, JESS rigidly fixes bones. Compress, neutralize, or distract a fracture fragment to aggressively treat bone and soft tissue injuries. Moving the proximal and distal joints instantly reduces edema, capsular fibrosis, joint stiffness, and muscle atrophy. Kirschner wires are the easiest, cheapest, and most versatile hand injury treatment. They can be percutaneously introduced. It allows early movements without surgical stress This study compares intramedullary Kirschner wires and Joshi’s external fixator device for unstable extra-articular metacarpal fractures.

A COMPARATIVE STUDY BETWEEN ILIZAROV RING FIXATOR AND JESS IN NEGLECTED/ RELAPSED CTEV

Background: Idiopathic clubfoot is one of the oldest and commonest congenital deformities of mankind, ever since man has adopted the erect posture. Franke (1987-90) used Ilizarov ring xator to correct all components of clubfoot. On the basis of similar principles, Joshi et al devised a simple external xator (Joshi's External Stabilization System- JESS). A total of 21 patients with 28 affected feet who met t Materials and Methods: he inclusion criteria were included in the study and divided into 2 groups; one group of 15 feet treated by Ilizarov xator and other group of 13 feet treated by JESS. All the cases were assessed pre operatively and post operatively clinically using Dimeglio classication scoring system and radiologically using angles and indices. This study included patients of Results and Conclusion: age 3 to 12 years with majority below 8 years. Clinical assessment using Dimeglio scoring system showed improvement in score post operatively in both the groups. In our study, 15 feet were treated by Ilizarov in which 4 feet (27%) had excellent results, 6 (40%) were good, 2 (13%) were fair and 3 (20%) were poor results and 13 feet were treated by JESS in which 2 (15%) had excellent results, 3 (23%) were good, 3 (23%) were fair and 5 (39%) were poor results. In our study, results are better in ilizarov as compared to JESS

Abstract for Thesis on Functional Outcome in Fracture in Lower End Radius in Patients Treated with Joshi External Stabilizing System (JESS FIXATOR)

Abstract for Thesis on Functional Outcome in Fracture in Lower End Radius in Patients Treated with Joshi External Stabilizing System (JESS FIXATOR)

Joshi's external stabilization system and K-wire fixation in the management of hand fractures – A prospective comparative study

Background: Hand fractures can be treated conservatively or surgically, depending on the severity, location, and type of fracture, as in conservative management chance of nonunion, malunion, and stiffness is more if it is displaced or angulated fracture. Various modes of treatment have been used which include K-wire fixation, mini plates, and external fixator application. A modified form of mini-external fixator devised in India is Joshi's External Stabilization System (JESS). Aim: This prospective study was conducted to compare the functional and radiological outcomes following metacarpal/phalangeal fracture fixed with either K-wire or JESS. Materials and Methods: Forty patients with hand fractures (58 fractures – 18 metacarpal and 40 phalanges) were prospectively studied. Twenty patients underwent K-wire fixation and 20 were fixed with JESS, functional and radiological outcomes were assessed, grip strength using dynamometer, visual analog scale (VAS) score, disabilities of the arm, shoulder, and hand (DASH) score, range of motion (ROM) using the American Society for Surgery of the hand scale, tip pinch strength. Student's t-test, Wilcoxon test, Fisher's exact test, and Chi-squared test were used. Results: At 6 months' follow-up, patients fixed with either of the fixation modality showed statistically significant improvement in different outcome variables such as ROM (P < 0.001), quick DASH score (P < 0.001), VAS score (P < 0.001), tip pinch strength (P < 0.001), and hand grip (P < 0.001). All the fractures united at an average 6 weeks. Functional outcomes were excellent in closed fracture fixed with either JESS or K-wire and good to moderate in open injuries. However, overall comparison between K-wire and JESS, no significant difference in these outcome measures was found. Conclusions: K-wires as well as JESS both provide adequate stability and satisfactory results in fractures of the metacarpal and phalanges. This study could not find the superiority of JESS over traditional K-wire fixation.

Joshi's external stabilization system fixator – A mini solution to avert major disabilities in hand injuries

Background: Fractures of hand bones are often considered minor injuries and treatment is either delayed or neglected. These fractures are usually treated conservatively that leaves behind a residual functional deficit. Surgical intervention should be considered for open, unstable, multiple, comminuted, or intra-articular fractures. Standard surgical treatment includes the use of K-wire, plate, or mini-screws which are associated with unsatisfactory results and high complication rates. Joint stiffness is a commonly reported complication with most of the existing devices used for hand bone fractures. There is a deficit of data pertaining to the effectiveness of Joshi's External Stabilization System (JESS) in avoiding joint stiffness. Joshi's external fixator is a reliable treatment of phalangeal and metacarpal fractures of the hand. It is an economical, simple, lightweight, and stable contract. Patients and Methods: We report a prospective cohort study of 30 patients of hand bone fracture, 10–60-year age range, treated by JESS. Functional evaluation was made using the Duncan et al. scoring. Results: The results recorded were excellent in 31.58% of cases, good in 42.11% of cases, fair in 21.05%, and poor in 5.26% of patients. Conclusion: JESS ex-fix for hand is a useful construct that allows early mobilization of nearby joints. It can be considered a suitable choice for the management of phalangeal and metacarpal fractures of hand to deliver good functional outcome.

SIMPLE AND EFFECTIVE METHOD FOR MANAGEMENT OF FRACTURES OF BASE OF 1ST METACARPAL USING LIGAMENTOTAXIS AND MINI EXTERNAL FIXATOR FRAME

Background- Fractures of the base of rst metacarpal include intra-articular fractures like Rolando fracture and Benette fracture. The ideal management modality of these fractures remains elusive. Management varies from conservative therapy, k wire xations, external xators to formal open reduction and plate xation. Open reduction and anatomic xation though lucrative, is frought with complications like stiffness, implant failure etc due to excessive dissection and soft tissue stripping that is required. Conservative therapy is usually insufcient to allow the fracture to heal in appropriate position as there are numerous muscle forces acting at the base of rst metacarpal which make maintaining the reduction difcult. K wires allow to keep the fracture reduced but obtaining reduction is not an easy task. Here we describe a minimally invasive technique using mini external xator-JESS(Joshi external stabilization system) which requires minimum soft tissue dissection In this prospective study a total of 8 pati Results- ents were included who underwent fracture xation using mini external xator frame. The average time to union was 4 weeks. None of the patients had iatrogenic injury to supercial branch of radial nerve. All of the patients had excellent post xator frame removal hand function. MethodsA prospective analysis was carried out over 8 months. A total of 8 patients met the inclusion criteria and were operated with mini external xator. Regular follow up was done till 8 weeks. At each postoperative visit patients were evaluated for hand function using Kapandji Score Radiographs were taken at each visit to evaluate for fracture alignment and union. Mini Conclusionexternal xator is a simple, minimally invasive surgical technique with excellent functional outcomes for management of Fractures of rst metacarpal

Management of mangled hand injuries with JESS fixator in a tertiary care hospital in North East India: A prospective study

IntroductionMangled hand injuries have proved to be a tough challenge for both the patients and surgeons alike. Severe bony and soft tissue injuries necessitate the requirement of a multidisciplinary approach. MaterialsIn our tertiary care facility, a prospective study was done on the use of the Joshi's external stabilization system (JESS) fixator in the treatment of 31 instances with mangled hand injuries from November 2019 to November 2020. The cases were evaluated for functional outcome at the end of 12 months of follow up. Results31 cases of mangled hand injuries with 43 fractures were treated with the said intervention. The mean age of the patients was 33.7 ± 4.2 years and almost 90% patients were males. Machinery injuries were the most frequent type of injury (55%). Cases were intervened at an emergency basis within 24 h of the injury. Functional evaluation was done by Modified Mayo Wrist Score with an average score of 84 ± 10. Good results were seen in about 60% of cases and there were no Poor results. ConclusionThe application of JESS fixator for the prompt treatment of mangling hand injuries yielded satisfactory results in the working population with an early return to function. The strict adherence to the principles of ligamentotaxis, appropriate wound care and post-operative physiotherapy are other variables in the final outcome of such injuries. Level of evidenceII.

To Study Functional Outcome for Upper Limb Phalanx Fracture Treated by JESS Fixator

Purpose: To study functional outcome for upper limb phalanx fracture treated by Joshi’s External Stabilizing System (JESS) fixator. Material and Methods: 68 patients were operated for Upper limb phalynx fracture in a tertiary health care setup with JESS fixator and were reviewed at 3 weeks, 6 weeks and 3months. After the procedure, the patients were assessed for the functional outcome using DASH (Disabilities or Arm, Shoulder and Hand) scoring scale. Results: Mean Adjusted DASH scores of the operated finger over consequent visits at 3 weeks, 6 weeks, and 3 months. We found that the mean adjusted DASH score improved in each consequent visit as compared to the first visit for all the joints (p&lt;0.001). Out of the total 68 study participants, 63 had no complications (92.65%). Only 5 study participants had complications, out of which 2 each had joint stiffness (2.94%) and superficial pin track infection (2.94%) while 1 had pin loosening (1.47%). Conclusion: From the results, we can safely conclude that JESS is an effective alternative treatment for fractures of the phalanges. It is cheap and easily available. Technically, also it is less demanding. Also there is a good functional outcome as suggested by our study findings in terms of improvement in the range of motion as well as the mean adjusted DASH scores over a period of three follow up visits planned at 3 weeks, 6 weeks and 3 months with very few complications.

Functional Outcome of Proximal Humerus Fracture Managed Surgically by Joshi's External Stabilizing System

INTRODUCTION: The ideal management of proximal humerus fracture is still controversial despite various treatment options. Conservative treatment with slab is fraught with shoulder stiffness and malunion while surgical treatment with plates and nail is fraught with infection and blood loss. Therefore, Joshi External Stabilization System (JESS) being a minimally invasive percutaneous procedure can be the ideal treatment for these fractures. MATERIAL AND METHODS: This prospective and observational hospital based study was carried out in Orthopedics Department, Universal College of Medical Sciences Teaching Hospital (UCMS-TH) from December 2018 to January 2021. All patients with traumatic proximal humerus fracture who fulfilled the inclusion criteria were enrolled in the study and were treated with JESS. Fracture was classified according to Neer classification and functional outcome was assessed according to Constant Murley Score (CMS) system. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months. RESULTS: There was statistically significant difference in VAS score (p&lt;0.05) measured at six weeks, three months and six months; and CMS (p&lt;0.05) at three months and six months. There was statistically significant difference between fracture type (Neer type) and fracture union (p&lt;0.05). But the association between functional outcome and type of fracture was statically insignificant (p&gt;0.05). CONCLUSION: Displaced proximal humerus fracture when treated surgically with JESS has good functional and radiological outcome. It produces less pain, less stiffness and greater Range of Motion (ROM).

JESS IN THE TREATMENT OF HAND AND FOOT INJURIES –AN USEFUL ARSENAL AS DAY CARE MANAGEMENT TOOL.

BACKGROUND: Small bone fractures of hand and feet are very common in a developing country like India and consist of 15% to 20% among all patients presenting at trauma centre and orthopaedic opds. Small bone fractures such as fractures of phalanx or metacarpals are often tend to be overlooked and of deemed as less serious in nature. However even a small deformity or disability of hand and feet can hamper the functional and psychological wellbeing of a person in long term. The purpose of this study is to evaluate the functional outcome and complications associated with application principles of JESS (Joshi's External Stabilization System) xation in phalanx, metacarpal and metatarsals and their management as a day care procedure. MATERIAL AND METHODS: This prospective observational study was done over a period of 1 year on 21 patients for injuries of metacarpal, phalanx and metatarsals and followed up for a minimum period of 3 months post frame removal. RESULTS: Young patients constituted almost 60% of the study population. RTA, assault and industrial / factory setup injury is most prevalent mode of injury. Over all closed injury patients had better functional outcome than open fractures. CONCLUSION: JESS is a versatile, easy to use system that can be applied at a very average set up. Optimum management of comminuted, open and unstable small bone fractures of hand and feet is possible with JESS. We advocate more extensive use of such a low cost and versatile system in Indian setup where cost of treatment is a major factor for going forward with a treatment option.

Joshi's external stabilization system versus locked compression plating in the management of tibial plateau fractures: A nonrandomized prospective study

Context: Among the myriad treatment options available for tibial plateau fractures, Joshi's external stabilization system (JESS) is one of the established treatment modalities as an external fixation device. Closed reduction has the advantage of biological fixation and preservation of the already jeopardized local blood supply to the bone. Aim: This study was conducted to compare the functional results between locked compression plate and JESS as a fixation method for tibial plateau fractures. Setting and Design: This is a prospective, single-center, and nonrandomized study. Materials and Methods: Fifty patients with tibial plateau fractures were included in the study, who presented to our hospital between January 2016 and December 2018 and were treated alternatively by either plating (Group P) or JESS (Group J). Modified Rasmussen functional score (MRFS) was used for assessing the functional outcomes. Statistical Analysis Used: Microsoft Excel and Statistical software SPSS version 21.0. Results: The mean age in Group J and P was 39.52 ± 9.27 years and 39.00 ± 10.82 years, respectively. The mean follow-up period was 12 months (range: 9–24 months). Schatzker Type II was the most common fracture pattern (n = 15). The average union time was 12.3 weeks in Group J and 14 weeks in Group P (P = 0.036). The mean MRFS at 3, 6, and 9 months of follow-up was significantly better in the J group (P value at 3 months was 0.0204, at 6 months was 0.0226, and at 9 months was 0.0048). Conclusion: The study shows that the functional outcome of JESS for the management of tibial plateau fractures is better than plating.

Comparative analysis between locking compression plate and Joshi's external stabilization system in the management of proximal tibial fractures

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Proximal tibial fractures present with a variety of patterns. They are mostly treated using plate osteosynthesis or Joshi's external stabilization system (JESS) depending upon the injury configuration and surgeon preference. We have compared the efficacy of plate fixation to JESS in the treatment of complex proximal tibial fractures.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: 36 patients of proximal tibial fractures with a mean age of 47 years were included in the study, 20 were treated using plate osteosynthesis while the other 16 were treated using JESS, they were followed up at regular intervals till 24 weeks and the progress was recorded in accordance with the knee society score (KSS) parameters&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: 20 patients were treated using plate osteosynthesis, 18 of them had excellent KSS scores, 2 patients recorded good scores, average range of flexion was 126&lt;sup&gt;o&lt;/sup&gt;, no incidences of superficial or deep infections were seen in any of them. Bone consolidation was achieved around 12 weeks in plate fixation group of the16 patients treated using JESS, 12 had excellent scores, 4 recorded a good score, average range of flexion was 118&lt;sup&gt;o&lt;/sup&gt;, superficial infection was seen in 2 patients, with no incidence of deep infection. Bone consolidation was achieved around 16 weeks in JESS group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;: Both open reduction internal fixation (ORIF) with plating and JESS appear to be adequate fixation methods for complex proximal tibial fractures, but as per our study plate fixation resulted in earlier bone consolidation and gave a slightly better functional outcome compared to JESS.&lt;/p&gt;

Results of JESS (Joshi's External Stabilizing System) in Relapsed, Neglected and Neurogenic Clubfoot in an Age Group of 2-10 Years.

Joshi's External Stabilization System (JESS) is an external fixator based methodology to correct different deformities of club foot using differential distraction. 31 difficult clubfeet feet in 24 patients who were neglected, neurogenic or relapsed were treated using JESS between July 2013 to June 2015 with an average follow-up of 4. 2 years. There were 16 males and 8 females in an age group of 2-10 years. 30 feet belonged to the severe and most severe group as per the Dimeglio Scoring System. All patients achieved correction of all components of the clubfoot. However, one patient required tibialis anterior transfer for dynamic forefoot adduction at the end of treatment. The mean total duration in JESS fixation was 69.5 days/foot (range 44-123 days) and the mean time to achieve correction within JESS averaged 52 days. The deformities improved from a mean Dimeglio score of 14.06 to 2.93. The objective radiological assessment of the deformities revealed improvements in the talocalcaneal angle on AP view from 16.39° to 34.52° and on lateral view from 15.97° to 33.03°. The Talo-1st metatarsal angle (AP view) improved from 35.29° to 7°. Complications included 11 cases of superficial pin tract infection, two instances of pin loosening and a case of pin cut out. There were three cases of 1st metatarsophalangeal dislocation that were managed by reversing the process of distraction. JESS is an effective method for managing difficult clubfeet.

An evaluation of congenital talipes equinovarus patients treated by various methods

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Idiopathic congenital talipes equinovarus is one of the commonest congenital anomaly. Although treatment provides many options, near universal agreement exists that initial management should consist of gentle manipulation of the affected foot. In developing country like India presentation is extremely variable from soon after birth to very late childhood and irregular follow up makes treatment more difficult.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 100 cases of congenital talipes equinovarus who attended the Orthopedics OPD of our hospital (March 2013 to 2016) were taken up. In neonates with delicate skin, the passive manipulation was demonstrated to the mother which they did 5-6 times daily. The application of plaster of Paris cast and passive manipulation was done every 15&lt;sup&gt;th&lt;/sup&gt; day upto 3 months of age. After the 3-month age, passive manipulation was done every 3 weeks. If no normalization, surgery was advised and done to correct the resistant component accordingly. All the analyses were performed in R-programming language (R- 3.0.0).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 6 cases,10 feet were lost during follow-up. Results were assessed in 134 feet, 128 cases managed conservatively, 13 surgically. Results were assessed according to clinical, radiological criteria of Beatson and Pearson. 13 feet were operated of 144 feet,11 cases posteromedial soft tissue release (PMSTR) was done. In two Joshi’s external stabilizing system (JESS) fixator was applied.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Majority of cases can be treated successfully by conservative means and only in 11 cases PMSTR was done, 2 cases of relapsed feet JESS was applied.&lt;/p&gt;

Proximal Humerus Fractures Managed With Joshi External Stabilizing System

Proximal humerus fractures account for 4% to 5% of all fractures. These fractures have been conventionally treated either conservatively in a shoulder immobilizer or by open reduction and internal fixation with a locking plate. Conservative treatment often leads to a stiff shoulder, and operative management requires extensive soft tissue dissection. In this study, we have chosen a middle path for treating proximal humerus fractures in the form of closed reduction and Joshi external stabilizing system (JESS) with early mobilization, thus overcoming the problem of shoulder stiffness associated with conservative management and excessive soft tissue dissection associated with the open procedure. We conducted a study on 25 patients with proximal humerus fractures with Neer types 2 and 3 fractures. The mean age was 49.6 years with a female preponderance of 64%. JESS was applied after closed reduction in all cases. Mobilization was started on days 1 or 2 of surgery. All patients were followed up at 2, 4, 6, and 8 weeks and at 6 months after surgery. All cases were evaluated functionally using the constant shoulder scoring system. In our study, the mean constant shoulder score was 75.7 at 6 months. All fractures united in 6 to 8 weeks. In our study, we had 2 cases of pin-tract infection and 1 case of shoulder stiffness. The JESS fixator is a good modality of treatment for Neer types 2 and 3 proximal humerus fractures, facilitating early mobilization without compromising on fracture stability and union rates.

Results of JESS (Joshi’s External Stabilizing System) in Relapsed, Neglected and Neurogenic Clubfoot in an Age Group of 2-10 Years

Background. Joshi’s External Stabilization System (JESS) is an external fixator based methodology to correct different deformities of club foot using differential distraction. Material and methods. 31 difficult clubfeet feet in 24 patients who were neglected, neurogenic or relapsed were treated using JESS between July 2013 to June 2015 with an average follow-up of 4. 2 years. There were 16 males and 8 females in an age group of 2–10 years. 30 feet belonged to the severe and most severe group as per the Dimeglio Scoring System. All patients achieved correction of all components of the clubfoot. Results. However, one patient required tibialis anterior transfer for dynamic forefoot adduction at the end of treatment. The mean total duration in JESS fixation was 69.5 days/foot (range 44-123 days) and the mean time to achieve correction within JESS averaged 52 days. The deformities improved from a mean Dimeglio score of 14.06 to 2.93. The objective radiological assessment of the deformities revealed improvements in the talocalcaneal angle on AP view from 16.39° to 34.52° and on lateral view from 15.97° to 33.03°. The Talo-1st metatarsal angle (AP view) improved from 35.29° to 7°. Complications included 11 cases of superficial pin tract infection, two instances of pin loosening and a case of pin cut out. There were three cases of 1st metatarsophalangeal dislocation that were managed by reversing the process of distraction. Conclusion. JESS is an effective method for managing difficult clubfeet.

Management of clubfoot in children above 5 years with differential distraction using joshi external stabilizing system

Introduction: Ponsetti's technique is the recommended procedure for treating idiopathic clubfoot in children below the age of 2 years, and the same is also followed in some severe clubfoot deformities including neglected, recurrent and resistant forms who eventually may need surgical intervention. In children >5 years of age (children belonging to 5–10 years), open surgical procedures make the foot rigid with soft-tissue surgery, and bony operations can make the foot even smaller. Simultaneous correction of all aspects of deformity by differential distraction using external fixator rescues the foot from such complications. Joshi's external stabilizing system (JESS) can be used to gradually correct the deformities by differential distraction. In comparison to Ilizarov ring fixators, these are lighter in weight, shorter, cheaper, and have an easier application. Purpose: The purpose of this study is to analyze the role of JESS fixator in correcting cases of clubfoot in children >5 years in terms of morphological, functional, and radiological outcomes which were assessed using the International Clubfoot Study Group (ICFSG) scores. Materials and Methods: Five consecutive children with eight clubfoot >5 years underwent differential fractional distraction in our hospital. Period of correction varied from 6 to 8 weeks, including the distraction phase and static phase. Follow-up was done by application of cast in plantigrade position for double the duration of corrective distraction. Patients were assessed preoperatively and postoperatively at 6 months for morphology, functionality, and radiological correction by the ICFSG score. Results: Excellent to good results were obtained in all cases, which were assessed using ICFSG score, with only minor complications in patients. Conclusion: JESS frame is simple, versatile, and best suited for correcting clubfoot deformities, which were neglected, resistant and recurrent, and also with residual deformity, even in the children above the age of 5 years with advanced osteoarticular development and higher rigidity.

Simultaneous lateral column shortening along with differential distraction by Joshi's external stabilization system for rigid neglected clubfoot correction.

Correction of rigid clubfoot in an older child by gradual differential distraction using the Ilizarov's device or Joshi's external stabilization system (JESS) is a time-consuming procedure. We simultaneously combined the lateral column shortening by cuboid wedge resection along with the differential distraction by application of JESS fixator for the treatment of severe, rigid, neglected, or relapsed congenital talipes equinovarus (CTEV) foot deformity in 30 feet in 18 children with mean age of 5.3 years and mean follow-up of 27.6 months. The mean pretreatment Pirani score was 5.3 which improved to mean Pirani score after treatment of 1.4. Excellent results were obtained in 22 (71.33%) feet, good results in four (13.33%) feet, and poor results in four (13.33%) feet. The average period for distraction in our series was 6.3 weeks, and total average period of fixator in place was 11.2 weeks. To conclude, lateral column shortening with JESS application simultaneously gives early good to excellent short-term results, and the combination of techniques permits rapid correction of deformity, and thus reducing the time for which the fixator is in place and hence has better acceptance by the patient.

Management of neglected, recurrent, and resistant congenital talipes equinovarus by controlled differential fractional distraction using the Joshi's external stabilization system

BackgroundClubfoot is a common congenital foot anomaly that requires patients to be presented to the orthopedic surgeon. ObjectivesThis study was conducted with the aim of assessing the efficacy in terms of the clinicoradiological outcome of the neglected, recurrent, and resistant congenital talipes equinovarus (CTEV) by ligamentotaxis using Joshi external stabilization system (JESS) fixators and evaluating the factors affecting the same. Material and methodA total of 30 children (34 feet) were evaluated after correction with differential distraction using the JESS. Outcome measuresAll were evaluated clinically and radiologically and scored as per the Catterall-Pirani scoring system, both before and after correction of the deformity. ResultsAll patients achieved good clinical results as per the Pirani score. Radiologically, all patients achieved the normal range of values. All findings were clinically significant. ConclusionJESS is a useful technique in neglected, resistant, relapse cases of CTEV or for any severity in patients aged between 1 and 10 years after a fair trial of Ponseti serial casting.