Cargando…

Evaluation of a surgical treatment algorithm for neglected clubfoot in low-resource settings

PURPOSE: Idiopathic clubfoot affects approximately 1/1000 alive-born infants, of whom 80–91% are born in low- or middle-income countries (LMICs). This retrospective study aimed to evaluate the morphological, functional, and social outcomes in patients with neglected clubfoot in rural Bangladesh, aft...

Descripción completa

Detalles Bibliográficos
Autores principales: Pigeolet, Manon, Imam, Saiful, Ninulescu, Gheorghe Cristian, Kabir, Shafiul, Smeesters, Pierre R., Mahmud, Hasib
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8752568/
https://www.ncbi.nlm.nih.gov/pubmed/34148119
http://dx.doi.org/10.1007/s00264-021-05058-6
_version_ 1784631900392914944
author Pigeolet, Manon
Imam, Saiful
Ninulescu, Gheorghe Cristian
Kabir, Shafiul
Smeesters, Pierre R.
Mahmud, Hasib
author_facet Pigeolet, Manon
Imam, Saiful
Ninulescu, Gheorghe Cristian
Kabir, Shafiul
Smeesters, Pierre R.
Mahmud, Hasib
author_sort Pigeolet, Manon
collection PubMed
description PURPOSE: Idiopathic clubfoot affects approximately 1/1000 alive-born infants, of whom 80–91% are born in low- or middle-income countries (LMICs). This retrospective study aimed to evaluate the morphological, functional, and social outcomes in patients with neglected clubfoot in rural Bangladesh, after receiving surgical treatment. METHODS: Patients received a posteromedial release (PMR) with or without an additional soft tissue intervention (group 1), a PMR with an additional bony intervention (group 2), or a triple arthrodesis (group 3) according to our surgical algorithm. Patients were followed until two year post-intervention. Evaluation was done using a modified International Clubfoot Study Group Outcome evaluation score and the Laaveg-Ponseti score. RESULTS: Twenty-two patients with 32 neglected clubfeet (ages 2–24 years) received surgical treatment. Nineteen patients with 29 clubfeet attended follow-up. At two year follow-up an excellent, good, or fair Laaveg-Ponseti score was obtained in 81% (group 1), 80% (group 2), and 0% (group 3) of the patients (p value 0.0038). Age at intervention is inversely correlated with the Laaveg-Ponseti score at two year follow-up (p < 0.0001). All patients attended school or work and were able to wear normal shoes. CONCLUSION: Our treatment algorithm is in line with other surgical algorithms used in LMICs. Our data reconfirms that excellent results can be obtained with a PMR regardless of age. Our algorithm follows a pragmatic approach that takes into account the reality on the ground in many LMICs. Good functional outcomes can be achieved with PMR for neglected clubfoot. Further research is needed to investigate the possible role of triple arthrodesis. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00264-021-05058-6.
format Online
Article
Text
id pubmed-8752568
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Springer Berlin Heidelberg
record_format MEDLINE/PubMed
spelling pubmed-87525682022-01-20 Evaluation of a surgical treatment algorithm for neglected clubfoot in low-resource settings Pigeolet, Manon Imam, Saiful Ninulescu, Gheorghe Cristian Kabir, Shafiul Smeesters, Pierre R. Mahmud, Hasib Int Orthop Original Paper PURPOSE: Idiopathic clubfoot affects approximately 1/1000 alive-born infants, of whom 80–91% are born in low- or middle-income countries (LMICs). This retrospective study aimed to evaluate the morphological, functional, and social outcomes in patients with neglected clubfoot in rural Bangladesh, after receiving surgical treatment. METHODS: Patients received a posteromedial release (PMR) with or without an additional soft tissue intervention (group 1), a PMR with an additional bony intervention (group 2), or a triple arthrodesis (group 3) according to our surgical algorithm. Patients were followed until two year post-intervention. Evaluation was done using a modified International Clubfoot Study Group Outcome evaluation score and the Laaveg-Ponseti score. RESULTS: Twenty-two patients with 32 neglected clubfeet (ages 2–24 years) received surgical treatment. Nineteen patients with 29 clubfeet attended follow-up. At two year follow-up an excellent, good, or fair Laaveg-Ponseti score was obtained in 81% (group 1), 80% (group 2), and 0% (group 3) of the patients (p value 0.0038). Age at intervention is inversely correlated with the Laaveg-Ponseti score at two year follow-up (p < 0.0001). All patients attended school or work and were able to wear normal shoes. CONCLUSION: Our treatment algorithm is in line with other surgical algorithms used in LMICs. Our data reconfirms that excellent results can be obtained with a PMR regardless of age. Our algorithm follows a pragmatic approach that takes into account the reality on the ground in many LMICs. Good functional outcomes can be achieved with PMR for neglected clubfoot. Further research is needed to investigate the possible role of triple arthrodesis. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00264-021-05058-6. Springer Berlin Heidelberg 2021-06-19 2022-01 /pmc/articles/PMC8752568/ /pubmed/34148119 http://dx.doi.org/10.1007/s00264-021-05058-6 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Paper
Pigeolet, Manon
Imam, Saiful
Ninulescu, Gheorghe Cristian
Kabir, Shafiul
Smeesters, Pierre R.
Mahmud, Hasib
Evaluation of a surgical treatment algorithm for neglected clubfoot in low-resource settings
title Evaluation of a surgical treatment algorithm for neglected clubfoot in low-resource settings
title_full Evaluation of a surgical treatment algorithm for neglected clubfoot in low-resource settings
title_fullStr Evaluation of a surgical treatment algorithm for neglected clubfoot in low-resource settings
title_full_unstemmed Evaluation of a surgical treatment algorithm for neglected clubfoot in low-resource settings
title_short Evaluation of a surgical treatment algorithm for neglected clubfoot in low-resource settings
title_sort evaluation of a surgical treatment algorithm for neglected clubfoot in low-resource settings
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8752568/
https://www.ncbi.nlm.nih.gov/pubmed/34148119
http://dx.doi.org/10.1007/s00264-021-05058-6
work_keys_str_mv AT pigeoletmanon evaluationofasurgicaltreatmentalgorithmforneglectedclubfootinlowresourcesettings
AT imamsaiful evaluationofasurgicaltreatmentalgorithmforneglectedclubfootinlowresourcesettings
AT ninulescugheorghecristian evaluationofasurgicaltreatmentalgorithmforneglectedclubfootinlowresourcesettings
AT kabirshafiul evaluationofasurgicaltreatmentalgorithmforneglectedclubfootinlowresourcesettings
AT smeesterspierrer evaluationofasurgicaltreatmentalgorithmforneglectedclubfootinlowresourcesettings
AT mahmudhasib evaluationofasurgicaltreatmentalgorithmforneglectedclubfootinlowresourcesettings