Chunho Chen1, Ting-Ming Wang2, Kuan-Wen Wu3, Shier-Chieg Huang2, Ken N Kuo4. 1. Department of Orthopedic Surgery, Chiayi Christian Hospital, Chiayi, Taiwan; Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, National Taiwan University, Taipei, Taiwan. 2. Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, National Taiwan University, Taipei, Taiwan. 3. Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: wukuanwen@gmail.com. 4. Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, National Taiwan University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
Abstract
BACKGROUND/ PURPOSE: In last century, two distinctive methods of manipulation and casting were developed, Kite method and Ponseti method. The purpose of this study is to compare the outcomes of parallel series between two methods in one institution. METHODS: From 2003 to 2008, two pediatric orthopedic services in one institution treated 57 patients with 88 idiopathic clubfeet. One service continued using Kite casting method consisted of 58 feet, and other service employed Ponseti casting method consisted of 30 feet. There was a minimum of 4 years follow-up. RESULTS: Both groups had similar Dimeglio severity scores before treatment. Initial correction was achieved in 40 feet (69%) in the Kite group compared with 27 feet (90%) in the Ponseti group, while 19 feet (63.3%) had percutaneous Achilles tenotomy. The Ponseti method was found to have a significantly higher correction rate (p = 0.028). After a mean follow-up of 72 months, there were 29 relapses (50%) in the Kite group and 8 relapses (26.7%) in the Ponseti group with significant difference (p = 0.036). At the latest follow-up, the outcome measures were 24 feet (41.4%) good, 18 feet (31%) fair and 16 (27.6%) poor in the Kite group and 25 feet (83.3%) good, 3 feet (10%) fair and 2 feet (6.7%) poor in the Ponseti group with significant difference between two groups (p < 0.001). CONCLUSION: In this simultaneous series of two casting methods in a single institution with more than 4 years follow up, we concluded that Ponseti method significantly achieved better midterm outcome in clubfoot management.
BACKGROUND/ PURPOSE: In last century, two distinctive methods of manipulation and casting were developed, Kite method and Ponseti method. The purpose of this study is to compare the outcomes of parallel series between two methods in one institution. METHODS: From 2003 to 2008, two pediatric orthopedic services in one institution treated 57 patients with 88 idiopathic clubfeet. One service continued using Kite casting method consisted of 58 feet, and other service employed Ponseti casting method consisted of 30 feet. There was a minimum of 4 years follow-up. RESULTS: Both groups had similar Dimeglio severity scores before treatment. Initial correction was achieved in 40 feet (69%) in the Kite group compared with 27 feet (90%) in the Ponseti group, while 19 feet (63.3%) had percutaneous Achilles tenotomy. The Ponseti method was found to have a significantly higher correction rate (p = 0.028). After a mean follow-up of 72 months, there were 29 relapses (50%) in the Kite group and 8 relapses (26.7%) in the Ponseti group with significant difference (p = 0.036). At the latest follow-up, the outcome measures were 24 feet (41.4%) good, 18 feet (31%) fair and 16 (27.6%) poor in the Kite group and 25 feet (83.3%) good, 3 feet (10%) fair and 2 feet (6.7%) poor in the Ponseti group with significant difference between two groups (p < 0.001). CONCLUSION: In this simultaneous series of two casting methods in a single institution with more than 4 years follow up, we concluded that Ponseti method significantly achieved better midterm outcome in clubfoot management.