Congenital clubfoot treatment with external fixation: Italian experience since 2006

The term “neglected clubfoot” encompasses several clinical pictures from inveterate clubfoot to relapsed clubfoot or to resistant clubfoot. Treatment with external fixators is a valid option in several case series. In our retrospective study, we wanted to analyze the results obtained in correcting the relapsed /inveterate clubfoot by using external fixators. In our Unit 101 patients underwent surgical procedures for congenital clubfoot correction from September 2006 to August 2019. A total of 8 patients (6 male and 2 female) were enrolled in the present study; in two cases the deformity was bilateral so that the total number of feet considered is 10. The age range of the patients considered at the first treatment of the clubfoot with external fixator ranges from 5 to 10 years with an average age of 7.3 years. The follow-up range is from 13 years to 4 months with an average follow-up of 6.5 years. Of the 10 feet treated with external fixator, 9 were subjected to correction using the Ilizarov apparatus (Ilizarov, TrueLok Orthofix, RRS Dial Medicali) and 1 through Taylor Spatial Frame (TSF Smith & Nephew). In evaluating the results of our study, we considered primary and secondary parameters. The primary outcome was therefore good for 7 feet (70%), discrete for 1 foot and poor in the 2 feet. There is a statistically evidence of all the subdomains of the 2 questionnaires administered (AOFAS and FFI) which demonstrate a clinal and mechanical improvement after treatment. No major complications were recorded among the patients. The principle of distraction-osteogenesis is a useful option and should be considered as a rescue solution in complex deformities. Its execution by surgeons with considerable experience is crucial. The new hexapod fixators simplify the correction process but remain useful tools in expert hands.