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Medial column stabilization improves the early result of calcaneal lengthening in children with cerebral palsy.
MedLine Citation:
PMID:  23531550     Owner:  NLM     Status:  In-Data-Review    
Calcaneal lengthening is a popular surgical treatment for pronated foot deformity. The aim of this study is to assess the effectiveness of medial column stabilization in improving the results of calcaneal lengthening for pronated foot deformity in ambulatory children with cerebral palsy. Twenty-one consecutive (37 feet) children with cerebral palsy with pronated foot deformity who received calcaneal lengthening from 2004 to 2009 were reviewed. Talonavicular stabilizations were performed by either stapling alone or fusion depending on the children's age and correctability of midfoot deformity. Satisfaction rates were assessed using Mosca's radiographic, Mosca's clinical, and Yoo's clinical criteria. Talonavicular coverage angle was also measured. Results between groups with and without stabilization of the talonavicular joint were compared. Group 1 included 11 children (19 feet) who had no talonavicular stabilization. Group 2 included 10 children (18 feet) who had talonavicular fixation. Groups were further divided into subgroups A [Gross Motor Function Classification System (GMFCS)≤II] and B (GMFCS≥III). Factors including demography, geographical classification, functional status, and preoperative degree of deformity were similar between the two groups. After the operation, all four radiographic parameters improved significantly. The talonavicular coverage angle was better in group 2 than in group 1. Mosca's radiographic results were satisfactory in 73.68% of cases in group 1 and 100% in group 2; the difference was statistically significant (P=0.027). As for Mosca's clinical results, 63.16% in group 1 and 83.33% in group 2 achieved satisfactory results (P=0.156). On the basis of Yoo's criteria, the results were satisfactory in 57.89% of cases in group 1 and in 94.44% of cases in group 2 (P=0.012). Further analysis on the satisfaction rates between the subgroups showed similar results between the patients in subgroup 1A and 2A, and significantly better results in subgroup 2B than in subgroup 1B. Concurrent stabilization of the talonavicular joint is an effective method to improve clinical and radiographic results of calcaneal lengthening in children with cerebral palsy with pronated feet, and the effect is more significant in children with worse GMFCS levels.
Che-Nan Huang; Kuan-Wen Wu; Shier-Chieg Huang; Ken N Kuo; Ting-Ming Wang
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of pediatric orthopedics. Part B     Volume:  22     ISSN:  1473-5865     ISO Abbreviation:  J Pediatr Orthop B     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-03-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9300904     Medline TA:  J Pediatr Orthop B     Country:  United States    
Other Details:
Languages:  eng     Pagination:  233-9     Citation Subset:  IM    
aDepartment of Orthopaedic Surgery, National Taiwan University Hospital bCenter for Evidence Based Medicine, Taipei Medical University, Taipei cDepartment of Orthopaedic Surgery, National Taiwan University Hospital Hsin-Chu Branch dDepartment of Orthopaedic Surgery, National Taiwan University Hospital Chu-Tung Branch, Hsinchu, Taiwan.
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