Treatment of complex foot deformities with hexapod external fixator in growing children and young adult patients. Issue 5 (October 2019)

• Record Type: Journal Article
• Authors: Riganti, Simone; Coppa, Valentino; Nasto, Luigi Aurelio; Di Stadio, Mauro; Calevo, Maria Grazia; Gigante, Antonio Pompilio; Boero, Silvio
• Is Part Of: Foot and ankle surgery. Volume 25:Issue 5(2019)
• Page Start: 623
• Page End: 629
• Publication Date: 2019-10
• Subjects: Complex foot deformities -- Hexapod external fixator -- Clubfoot -- Distraction osteogenesis; Foot -- Surgery -- Periodicals; Ankle -- Surgery -- Periodicals; Ankle -- surgery -- Periodicals; Foot -- surgery -- Periodicals; Ankle -- Surgery; Foot -- Surgery; Periodicals; Electronic journals; 617.58
• DOI: 10.1016/j.fas.2018.07.001
• Languages: English
• ISSNs: 1268-7731

Abstract

Highlights: Complex foot deformities are three-dimensional, rigid deformities that can be difficult to treat in children and young adult patients. TL-HEX hexapod external fixator is a safe and effective tool for treatment of complex foot deformities with satisfying results. The main advantage of treatment with the hexapod external fixator is to allow correction with lengthening of the foot. The other advantage of the hexapod external fixator is that the correction plan can be dynamically adjusted during treatment. Learning curve for this kind of treatment can be steep, and long follow-up is recommended in order to identify late recurrences of the deformity. Abstract: Background: Treatment of complex foot deformities in growing children and young adult patients is challenging. The traditional approach consists of extensive soft tissues releases, osteotomies and/or arthrodesis. More recently, distraction osteogenesis has been proposed as an alternative strategy. The aim of this study was to describe our treatment strategy and report clinical outcomes of the patients affected from complex foot deformities treated by distraction osteogenesis and hexapod external fixator. Materials and methods: We retrospectively reviewed 10 consecutive patients with complex foot and ankle deformities treated from 2014 to 2016 at our unit. A TrueLok external fixator system was used in all patients. Final outcome was classified as good, fair and poor according to the criteria indicated by Paley and Ferreira. The results were also evaluated by the pre-operative and post operative American Orthopedic Foot and Ankle Score (AOFAS) and The Manchester-Oxford Foot Questionnaire (MOXFQ). Results: A plantigrade foot was obtained in eight patients at the end of treatment, while in two patients a recurrence of the deformity was noted. Result was classified as good in 6 patients, fair in 2 patients, and poor in 2 patients. The AOFAS score improved from 33.9 ± 21.2 pre-operatively to 67.25 ± 15.1 post-operatively (p = 0.005). A statistically significant improvement was observed for the MOXFQ score as well (from 60.6 ± 23.3 to 33.0 ± 25.2, p = 0.020). Conclusions: Our study shows that the TrueLok hexapod external fixator is a safe and effective tool in treatment of complex rigid foot deformities. Nevertheless, deformity recurrence can be observed in some cases and treatment remains challenging. Distraction osteogenesis should be reserved as a salvage solution for particularly complex cases and should be performed at dedicated specialized centers.