Percutaneous achillotomy in the treatment of congenital clubfoot: should it be performed in the operating theater or the
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RESEARCH ARTICLE
Open Access
Percutaneous achillotomy in the treatment of congenital clubfoot: should it be performed in the operating theater or the polyclinic? Ümit Tuhanioğlu* , Hasan U. Oğur, Fırat Seyfettinoğlu, Hakan Çiçek, Volkan T. Tekbaş and Ahmet Kapukaya
Abstract Background: The aim of this study was to compare the efficacy, advantages, and complications of percutaneous achillotomy in the treatment of clubfoot with the Ponseti method when performed to two different groups under general anesthesia or polyclinic conditions with local anesthesia. Methods: A retrospective evaluation was made of 96 patients treated for clubfoot in our clinic between January 2013 and June 2016. Fifty-seven patients were separated into two groups according to whether the achillotomy was performed in polyclinic conditions with local anesthesia or under general anesthesia following serial plaster casting with the Ponseti method. Results: The characteristics of age distribution, mean week of tenotomy, side, and sex were similar in both groups. No statistically significant difference was determined between the two groups in respect to complication and recurrence. The durations of hospitalization-observation, separation from the mother, and fasting were found to be statistically significantly shorter in local anesthesia group. Conclusion: Although the performance of percutaneous achillotomy with local or general anesthesia has different advantages, it can be considered that especially in centers with high patient circulation, achillotomy with local anesthesia can be more preferable to general anesthesia because it is practical and quick, does not require a long period of fasting or hospitalization, and has a similar complication rate to general anesthesia procedures. Keywords: Ponseti, Achillotomy, Clubfoot
Background Congenital clubfoot deformity is a congenital deformity that can be successfully treated with current conservative methods, and when not treated, can cause severe pain and functional impairments [1]. It is seen at the rate of 5 in 10,000 births [2]. The Ponseti method is a widely accepted and used method for the treatment of congenital clubfoot. As positive results have been reported with this method in extensive series and long-term follow-up studies, it has been accepted by many authors as the gold standard in congenital clubfoot treatment [3–8]. The Ponseti method is a comprehensive * Correspondence: [email protected] Department of Orthopaedics and Traumatology, University of Health Science Adana City Hospital, Adana, Turkey
treatment method in which cavus, adduction, and heel varus deformities are corrected with a series of plaster casts, and in most cases, there is a need for intervention for the equinus with a percutaneous achillotomy. Finally, to protect the correction, there is need for long-term use of a brace [8]. Although the Ponseti method seems to be simple in application, there are sensitive points such as manipulating the plaster cast, percutaneous achillotomy, and the use of a brace. Incorrec
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