EVALUATION OF RESULTS OF GRADUAL DISTRACTION TECHNIQUE FOR CORRECTION AND FUNCTIONAL RECOVERY OF NEGLECTED CTEV

Abstract

INTRODUCTION: Congenital talipes equinovarus (CTEV) or clubfoot is commonest congenital foot deformity. The incidence of Congenital Idiopathic Clubfoot ranges from 0.36/1000 to 6.8/1000 in some populations and about 1.2/1000 births among Caucasians including Indians, with a 1 much higher occurrence in the affected families . More common in male (2:1). Bilateral cases account for about 50%. In unilateral cases right side affected more. The term talipes is derived from talus (ankle bone) and pes (foot). AIMS & OBJECTIVES:To assess the efcacy of gradual differential distraction with JESS as a method of treatment in neglected CTEV. Evaluation of functional recovery of neglected CTEVusing this technique. To assess the morbidity & complication of the technique. MATERIALS AND METHODS: Study area: - The study was institution based, conducted at the Orthopaedics department of I.P.G.M.E.R.& S.S.K.M. Hospital, Kolkata, a tertiary care centre catering to people of West Bengal and adjacent states of Eastern India Study population: Patients attending Orthopedics' O.P.D. of IPGMER & SSKM Hospital. Study period: From May 2016 to Oct 2017 (18 months duration) Sample size: 20 patients (24 feet) Sample design: Patient selection: RESULTS AND ANALYSIS: 2(8.3%) patients exion deformity of toes. 1(4.2%) Persitant cavus, 1(4.2%) had liniar skin necrosis, 1(4.2%) patients had pressure sore, 1(4.2%) had oedema of feet, 1(4.2%) persistent all deformity, 2(8.3%) patients had persistan tequinus, 5(20.8%) patients had persistant heel varus, 2(8.3%) patients had forfoot adduction, 3(12.5%) patients had pin tract infection and 11(45.8%) had no complication. 4(16.7%) patients had excellent functional outcome, 8(33.3%) patients had good functional outcome, 8(33.3%) patients had moderate functional outcome and 4(16.7%) patients had poor functional outcome. CONCLUSION: In our study 12(82.3%) feet had excellent to moderate result, only 4(16.7%) had poor result with limited complication. Few patients left with one or more persistent deformity but the nal outcome was functionally satisfactory. JESS is an excellent technique in the management of neglected cases of CTEV especially when it is done at an early age. Differential distraction by JESS xator for the correction of neglected idiopathic CTEV is an effective and patient-friendly method of management. Therefore the differential distraction with JESS can be considered as a treatment modality for the neglected CTEV.