Uglow, M. G. and Clarke, Nicholas M. P.
Relapse in staged surgery for congenital talipes equinovarus
Journal of Bone and Joint Surgery, British Volume, 82-B, (5), . (PMID:10963177).
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Between 1988 and 1995, we studied 91 club feet
from a series of 120 recalcitrant feet in 86 patients
requiring surgical treatment. There were 48 boys and
20 girls. The mean age at operation was 8.9 months.
Surgery consisted of an initial plantar medial release
followed two weeks later by a posterolateral release.
This strategy was adopted specifically to address the
problems of wound healing associated with
single-stage surgery and to ascertain the rate of
relapse after a two-stage procedure. Immobilisation in
plaster was used for three months followed by night
splintage. The feet were classified preoperatively and
prospectively into four grades according to the system
suggested by Dimeglio et al. Grade-1 feet were
postural and did not require surgery. All wounds were
closed primarily. One superficial wound infection
occurred in a grade-4 foot and there were no cases of
wound breakdown. The rate of relapse was 20.4% in
grade-3 and 65.4% in grade-4 feet.
Two-stage surgery for the treatment of club foot
seems to be effective in the reduction of wound
problems but does not appear to give significantly
better results in terms of relapse when performed for
more severe deformities.
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