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Current Clubfoot Practices: POSNA Membership Survey
Clubfoot management has advanced in the 21st century with increases in formal training, practitioner experience, and improved casting/bracing constructs. The Ponseti method is the gold standard, yet variations in application persist. This survey aims to identify current treatment practices among clu...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10047051/ https://www.ncbi.nlm.nih.gov/pubmed/36979996 http://dx.doi.org/10.3390/children10030439 |
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author | Sax, Oliver C. Hlukha, Larysa P. Herzenberg, John E. McClure, Philip K. |
author_facet | Sax, Oliver C. Hlukha, Larysa P. Herzenberg, John E. McClure, Philip K. |
author_sort | Sax, Oliver C. |
collection | PubMed |
description | Clubfoot management has advanced in the 21st century with increases in formal training, practitioner experience, and improved casting/bracing constructs. The Ponseti method is the gold standard, yet variations in application persist. This survey aims to identify current treatment practices among clubfoot practitioners within the Pediatric Orthopaedic Society of North America (POSNA). A 23-question online survey of members was conducted between June and August 2021. Eighty-nine respondents self-identified as clubfoot providers. Of these, 93.1% had an MD degree, 23.6% possessed >30 years’ experience, and the majority (65.6%) worked in a teaching hospital associated with a medical school. Most responders (92.0%) were pediatric fellowship trained. A total of 51.7% had participated in a clubfoot training course. More than half (57.5%) noted changes to clubfoot management practices throughout their training. A majority used between four and seven (88.7%) long leg casts (98.4%), changed at seven-day intervals (93.4%). Plaster (69.4%) was most commonly used. The most common bracing device was Mitchell–Ponseti (72.9%). A mean 84.8% of clubfeet required tenotomy. The most common anesthetic agent was numbing gel (43.0%). Tenotomies mostly occurred in patients aged <6 months (63.1%). Tenotomy locations were operating room (46.5%), clinic (45.4%) and procedure room (8.1%). Cast removal was primarily performed with saws (54.7%). The mean incidence of observed cast burns was 5.5%. Most providers did not use a device to prevent cast burns (76.6%). Reported cast complications included slippage (85.9%), skin irritation (75.8%), and saw-related injuries (35.9%). Clubfoot management variations exist in orthotics, tenotomy indications and practices, and cast material. Casting complications continue to be a problem. Further studies are warranted to determine if certain practices predispose patients to specific complications. |
format | Online Article Text |
id | pubmed-10047051 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-100470512023-03-29 Current Clubfoot Practices: POSNA Membership Survey Sax, Oliver C. Hlukha, Larysa P. Herzenberg, John E. McClure, Philip K. Children (Basel) Brief Report Clubfoot management has advanced in the 21st century with increases in formal training, practitioner experience, and improved casting/bracing constructs. The Ponseti method is the gold standard, yet variations in application persist. This survey aims to identify current treatment practices among clubfoot practitioners within the Pediatric Orthopaedic Society of North America (POSNA). A 23-question online survey of members was conducted between June and August 2021. Eighty-nine respondents self-identified as clubfoot providers. Of these, 93.1% had an MD degree, 23.6% possessed >30 years’ experience, and the majority (65.6%) worked in a teaching hospital associated with a medical school. Most responders (92.0%) were pediatric fellowship trained. A total of 51.7% had participated in a clubfoot training course. More than half (57.5%) noted changes to clubfoot management practices throughout their training. A majority used between four and seven (88.7%) long leg casts (98.4%), changed at seven-day intervals (93.4%). Plaster (69.4%) was most commonly used. The most common bracing device was Mitchell–Ponseti (72.9%). A mean 84.8% of clubfeet required tenotomy. The most common anesthetic agent was numbing gel (43.0%). Tenotomies mostly occurred in patients aged <6 months (63.1%). Tenotomy locations were operating room (46.5%), clinic (45.4%) and procedure room (8.1%). Cast removal was primarily performed with saws (54.7%). The mean incidence of observed cast burns was 5.5%. Most providers did not use a device to prevent cast burns (76.6%). Reported cast complications included slippage (85.9%), skin irritation (75.8%), and saw-related injuries (35.9%). Clubfoot management variations exist in orthotics, tenotomy indications and practices, and cast material. Casting complications continue to be a problem. Further studies are warranted to determine if certain practices predispose patients to specific complications. MDPI 2023-02-23 /pmc/articles/PMC10047051/ /pubmed/36979996 http://dx.doi.org/10.3390/children10030439 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Brief Report Sax, Oliver C. Hlukha, Larysa P. Herzenberg, John E. McClure, Philip K. Current Clubfoot Practices: POSNA Membership Survey |
title | Current Clubfoot Practices: POSNA Membership Survey |
title_full | Current Clubfoot Practices: POSNA Membership Survey |
title_fullStr | Current Clubfoot Practices: POSNA Membership Survey |
title_full_unstemmed | Current Clubfoot Practices: POSNA Membership Survey |
title_short | Current Clubfoot Practices: POSNA Membership Survey |
title_sort | current clubfoot practices: posna membership survey |
topic | Brief Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10047051/ https://www.ncbi.nlm.nih.gov/pubmed/36979996 http://dx.doi.org/10.3390/children10030439 |
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