One-stage Posteromedial Release Research Articles

Surgical Treatment of Clubfoot

In a retrospective study on the surgical management of clubfoot based on clinical and radiographic assessments, 171 feet in 137 patients were reviewed. The surgical procedure was selected according to the degree of the deformity. The more severe cases (group A, 75 feet) were surgically treated according to Turco's one-stage posteromedial release, whereas the milder degrees of deformity (group B, 96 feet) were corrected by elongation of the Achilles tendon with posterior capsulotomy. The mean age of the patients at surgery was 12.5 months in group A and 5.2 months in group B. The mean follow-up time for both groups was 12.2 years. At follow-up, 24 feet (41%) in group A and 52 feet (68%) in group B required repeat surgery. In group A the results were good in 51 feet (68%), fair in 15 (20%), and poor in 9 (12%). In group B, good results were obtained in 44 feet (45%), barely satisfactory results in 25 (27%), and poor results in 27 (28%). It is suggested that the accurate correction of talocalcaneonavicular and calcaneocuboid malposition is a prerequisite for successful surgical treatment of clubfoot. There was a tendency for a better result in group A when the patients were surgically treated between 6 and 12 months of age.

Posteromedial release of congenital club foot in children over five years of age

We reviewed 19 children with 24 congenital club feet at a mean of 11 years after one-stage posteromedial release at the age of five years or older (mean 6.8 years). Thirteen feet had undergone previous surgery. Nineteen feet were functionally excellent or good, three were fair and two had required subtalar arthrodesis. Radiographs showed good alignment of the tarsal bones, although mild adduction or varus deformity remained in several feet. Deformities of the bones were more common in feet which had had previous surgery.

先天性内反足に対する手術的療法の検討

Eleven feet in 9 children previously treated by a conservative or operative method were reviewed clinically and radiologically. In nine feet treated by a one-stage posteromedial release operation (the Turco procedure), the talocalcaneal angle and the MTR angle were temporarily restored after that operation, but finally recurred. In five feet treated by a posterolateral release operation, four of which were treated by a calcaneocuboid arthrodesis at the same time, the MTR angle was restored after that operation, but the anteroposterior talocalcaneal angle was not.Our results suggested that calcaneo-cuboid arthrodesis was effective to treat a resistant deformity and that it was necessary to release soft tissue sufficiently before that. But, it seems difficult to release a talonavicular joint completely by a posterolateral approach. And we had better correct a deformity from both medial and lateral sides.

One-stage posteromedial release of congenital clubfoot.

Turco's one-stage posteromedial release with internal fixation has been performed in 51 children with a total of 73 congenital clubfeet since 1973. Thirty-one children (44 feet) followed for 4-12 years were evaluated using the McKay rating system. The occurrence of good and excellent results was 70%. The relationship between these results and angles measured from roentgenograms was analyzed using multiple regression. The results showed a closer relationship to the anteroposterior talocalcaneal angle, the tibiocalcaneal angle, and the MTR angle.

The appearance of the tarsal navicular after posteromedial release for clubfoot.

Sixty-one idiopathic clubfeet in 46 patients of an older population were treated by one-stage posteromedial release. Follow-up roentgenograms revealed dorsal subluxation of the tarsal navicular in 43% of the clubfeet. This abnormality is probably due to both closed manipulation and casting, and improper positioning of the navicular during posteromedial release. However, dorsal navicular subluxation did not adversely affect the results of treatment observed over the follow-up period that averaged nearly 6 1/2 years. Medial subluxation of the navicular was associated with unsatisfactory results, whereas a centrally located or laterally subluxed navicular generally produced good or excellent results. Other abnormalities of the navicular noted included wedging and avascular necrosis. The long-term consequences of these various abnormalities of the roentgenographic appearance and position of the navicular are not known.

Resistant congenital club foot--one-stage posteromedial release with internal fixation. A follow-up report of a fifteen-year experience.

I have reviewed my personal experience with 240 resistant congenital club feet (176 patients) treated surgically by one-stage posteromedial release with internal fixation. The end results in the 149 feet that had a follow-up of two to fifteen years were: excellent or good, 83.8 per cent; fair, 10.7 per cent; and failures, 5.3 per cent. The best results with the least complications were in children who were operated on between the ages of one and two years. A statistical analysis of fifty-three feet with a follow-up of less than two years is reported for comparison with the results after longer follow-up to allow analysis of all the known failures and complications that have been encountered with the operation. Possible causes and prevention of fair and poor results are discussed. Modifications of the technique, which originally was reported in 1971, are described.

Radical One-Stage Posteromedial Release for the Resistant Clubfoot

A large proportion of congenital talipes equinovarus is resistant to correction by nonoperative means. The authors reviewed 54 feet which required surgical intervention, and the operative management utilized was a radical one-stage posteromedial release. Application of plastic surgical techniques has obviated problems of skin healing. Comparable to results reported by others, a good-to-excellent functional and cosmetic result can be expected in 90% of the cases. Careful attention to a well-designed postoperative regimen will frequently obviate the need for additional surgery.

Surgical correction of the resistant club foot: One-stage postero-medial release with internal fixation: A preliminary report : V. J. Turco. J. Bone Joint Surg. 53A:477–497, 1971

Surgical correction of the resistant club foot: One-stage postero-medial release with internal fixation: A preliminary report : V. J. Turco. J. Bone Joint Surg. 53A:477–497, 1971