Markus Knupp1, Alexej Barg1, Lilianna Bolliger1, Ashley L Kapron2, Beat Hintermann1. 1. Department of Orthopaedic Surgery, Kantonsspital Liestal, CH-4410 Liestal, Switzerland. E-mail address for M. Knupp: markus.knupp@ksli.ch. E-mail address for A. Barg: alexejbarg@mail.ru. E-mail address for L. Bolliger: lilianna.bolliger@ksli.ch. E-mail address for B. Hintermann: beat.hintermann@ksli.ch. 2. Department of Orthopaedic Surgery, Harold K. Dunn Orthopaedic Research Laboratory, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address: ashley.kapron@utah.edu.
Abstract
INTRODUCTION: In our experience, a supramalleolar osteotomy with or without calcaneal osteotomy and midfoot osteotomy has been an effective treatment for sequelae resulting from overcorrected clubfoot deformity. STEP 1 PREOPERATIVE ASSESSMENT AND PLANNING: Determine the treatment using the decisional algorithm in Figure 3. STEP 2 PATIENT POSITIONING: Use spinal or general anesthesia, administer intravenous antibiotics, position the patient supine, apply a tourniquet. STEP 3 MEDIAL APPROACH TO THE DISTAL PART OF THE TIBIA: Use a medial approach to expose the distal part of the tibia. STEP 4 SUPRAMALLEOLAR OSTEOTOMY: Remove the bone wedge, close the osteotomy, and use rigid plate fixation to secure the correction. STEP 5 ADDITIONAL PROCEDURES IF NECESSARY: If necessary, perform fibular osteotomy, calcaneal osteotomy, and/or plantar flexion osteotomy of the first cuneiform. STEP 6 CLOSURE OF ALL INCISIONS AND POSTOPERATIVE CARE: A short leg splint is worn for two days, followed by partial weight-bearing with the ankle protected in a splint at night and a walking boot during the day for eight weeks. RESULTS: Between 2002 and 2009, fourteen adult patients (mean age, thirty-seven years; range, nineteen to sixty-six years) who presented with a symptomatic overcorrected clubfoot deformity were treated with a supramalleolar osteotomy. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: In our experience, a supramalleolar osteotomy with or without calcaneal osteotomy and midfoot osteotomy has been an effective treatment for sequelae resulting from overcorrected clubfoot deformity. STEP 1 PREOPERATIVE ASSESSMENT AND PLANNING: Determine the treatment using the decisional algorithm in Figure 3. STEP 2 PATIENT POSITIONING: Use spinal or general anesthesia, administer intravenous antibiotics, position the patient supine, apply a tourniquet. STEP 3 MEDIAL APPROACH TO THE DISTAL PART OF THE TIBIA: Use a medial approach to expose the distal part of the tibia. STEP 4 SUPRAMALLEOLAR OSTEOTOMY: Remove the bone wedge, close the osteotomy, and use rigid plate fixation to secure the correction. STEP 5 ADDITIONAL PROCEDURES IF NECESSARY: If necessary, perform fibular osteotomy, calcaneal osteotomy, and/or plantar flexion osteotomy of the first cuneiform. STEP 6 CLOSURE OF ALL INCISIONS AND POSTOPERATIVE CARE: A short leg splint is worn for two days, followed by partial weight-bearing with the ankle protected in a splint at night and a walking boot during the day for eight weeks. RESULTS: Between 2002 and 2009, fourteen adult patients (mean age, thirty-seven years; range, nineteen to sixty-six years) who presented with a symptomatic overcorrected clubfoot deformity were treated with a supramalleolar osteotomy. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
Authors: Kenneth Mathew Warnock; Brian Douglas Johnson; John Braxton Wright; Catherine Glauber Ambrose; Thomas Oscar Clanton; William Christopher McGarvey Journal: Foot Ankle Int Date: 2004-11 Impact factor: 2.827