103.
Dennyson-Fulford subtalar extra-articular arthrodesis for severe
hindfoot valgus in children. A retrospective study.
Polina Martinkevich
Department of Children's Orthopaedics Aarhus University Hospital
Background:
The Dennyson-Fulford subtalar extra-articular arthrodesis is an
acknowledged method for correction of severe valgus hindfoot deformities in
children. The literature reports no consensus on an acknowledged treatment
regime for patients submitted to the procedure.
Purpose / Aim of Study:
The method is surgically demanding and there is no
standardized treatment regime at Aarhus University Hospital. We evaluate our
experience with the technique.
Materials and Methods:
During 1996-2010, 51 arthrodeses were performed
in 33 children with severe, flexible hindfoot valgus deformities. We performed
a review of the medical records, identifying indications for surgery,
complications to the procedure and clinical outcome. Radiographs taken at 6
weeks after surgery and at a mean time of 3 years were reviewed, in order to
assess healing. The Gross Motor Function Classification System (GMFCS)
was used to assess the gross motor function in patients with cerebral palsy
before and after surgery. We defined a successfull result as clinical healing at 3
months, correction of the deformity, improved mobility, radiographic healing
and no revision surgery.
Findings / Results:
The mean age at the time of surgery was 11,7 years (range
4,7; 16,9).
Clinical healing was achieved in all 51 feet at 10 weeks after
surgery. Revision surgery was performed in 10 feet primary due to
complications related to hardware failure, such as malpositioning of the screw,
screw size and breakage. Satisfactory clinical outcome was obtained in 41 out
of 51 feet. Healing was difficult to assess from conventional radiographs.
Conclusions:
Successfull results in 41 out of 51 feet based on clinical healing,
improved mobility, absence of pain and no revision surgery. Bony union could
not be assessed adequately from conventional radiographs. Carefull attention
must be paid to screw insertion.
