Catherine Hui1, Elaine Joughin2, Alberto Nettel-Aguirre3, Simon Goldstein2, James Harder2, Gerhard Kiefer2, David Parsons2, Carmen Brauer2, Jason Howard4. 1. The Division of Orthopaedic Surgery, Department of Surgery, University of Alberta, Edmonton, Alta. 2. The Division of Orthopaedic Surgery, Department of Surgery, Alberta Children's Hospital, Calgary, Alta. 3. The Departments of Paediatrics and Community Health Sciences, Alberta Children's Hospital, Calgary, Alta. 4. The Division of Orthopaedic Surgery, Department of Surgery, Sidra Medical and Research Center, Doha, Qatar.
Abstract
BACKGROUND: The Ponseti method of congenital idiopathic clubfoot correction has traditionally specified plaster of Paris (POP) as the cast material of choice; however, there are negative aspects to using POP. We sought to determine the influence of cast material (POP v. semirigid fibreglass [SRF]) on clubfoot correction using the Ponseti method. METHODS: Patients were randomized to POP or SRF before undergoing the Ponseti method. The primary outcome measure was the number of casts required for clubfoot correction. Secondary outcome measures included the number of casts by severity, ease of cast removal, need for Achilles tenotomy, brace compliance, deformity relapse, need for repeat casting and need for ancillary surgical procedures. RESULTS: We enrolled 30 patients: 12 randomized to POP and 18 to SRF. There was no difference in the number of casts required for clubfoot correction between the groups (p = 0.13). According to parents, removal of POP was more difficult (p < 0.001), more time consuming (p < 0.001) and required more than 1 method (p < 0.001). At a final follow-up of 30.8 months, the mean times to deformity relapse requiring repeat casting, surgery or both were 18.7 and 16.4 months for the SRF and POP groups, respectively. CONCLUSION: There was no significant difference in the number of casts required for correction of clubfoot between the 2 materials, but SRF resulted in a more favourable parental experience, which cannot be ignored as it may have a positive impact on psychological well-being despite the increased cost associated.
RCT Entities:
BACKGROUND: The Ponseti method of congenital idiopathic clubfoot correction has traditionally specified plaster of Paris (POP) as the cast material of choice; however, there are negative aspects to using POP. We sought to determine the influence of cast material (POP v. semirigid fibreglass [SRF]) on clubfoot correction using the Ponseti method. METHODS:Patients were randomized to POP or SRF before undergoing the Ponseti method. The primary outcome measure was the number of casts required for clubfoot correction. Secondary outcome measures included the number of casts by severity, ease of cast removal, need for Achilles tenotomy, brace compliance, deformity relapse, need for repeat casting and need for ancillary surgical procedures. RESULTS: We enrolled 30 patients: 12 randomized to POP and 18 to SRF. There was no difference in the number of casts required for clubfoot correction between the groups (p = 0.13). According to parents, removal of POP was more difficult (p < 0.001), more time consuming (p < 0.001) and required more than 1 method (p < 0.001). At a final follow-up of 30.8 months, the mean times to deformity relapse requiring repeat casting, surgery or both were 18.7 and 16.4 months for the SRF and POP groups, respectively. CONCLUSION: There was no significant difference in the number of casts required for correction of clubfoot between the 2 materials, but SRF resulted in a more favourable parental experience, which cannot be ignored as it may have a positive impact on psychological well-being despite the increased cost associated.
Authors: Matthew B Dobbs; J R Rudzki; Derek B Purcell; Tim Walton; Kristina R Porter; Christina A Gurnett Journal: J Bone Joint Surg Am Date: 2004-01 Impact factor: 5.284
Authors: Vivian Welch; J Jull; J Petkovic; R Armstrong; Y Boyer; L G Cuervo; Sjl Edwards; A Lydiatt; D Gough; J Grimshaw; E Kristjansson; L Mbuagbaw; J McGowan; D Moher; T Pantoja; M Petticrew; K Pottie; T Rader; B Shea; M Taljaard; E Waters; C Weijer; G A Wells; H White; M Whitehead; P Tugwell Journal: Implement Sci Date: 2015-10-21 Impact factor: 7.327