This study aimed to examine the results of manipulation and serial casting, followed by open Achilles lengthening combined, when necessary, with posterior release in the management of neurologic clubfoot in infants with myelomeningocele. This study was carried out prospectively with a minimum follow-up of 2 years on 24 consecutive infants (48 feet) with neurologic insensate feet. Manipulation and serial casting were performed, followed by open tendo Achilles lengthening with/without posterior capsulotomy of the ankle and subtalar joints. The Diméglio scoring system was used to assess the degree of deformity correction immediately postoperatively and the latest follow-up visits. The mean age of the patients at initial treatment was 5.9 (3-8) weeks. None of the patients was lost to follow-up. For 36 feet, the final range of scores was 5-6 and the deformities were grade II of moderate type. Only for seven of 48 feet the final scores were in the range 10-12, grade III, and severe type. Only three infants (5/48 feet) failed to show any improvement. We thus support this treatment for the management of insensate feet of infants with myelomeningocele soon after birth as most infants responded satisfactorily in terms of deformity correction and achieved plantigrade mobile feet that fit into orthotics.
The optimal treatment of complex tibial plateau fractures in elderly is still controversial. The aim of the study was to retrospectively analyze the clinical and radiological outcomes of primary total knee arthroplasty (TKA) versus open reduction and internal fixation (ORIF) in elderly patients presenting with acute complex tibial plateau fractures. Between June 2011 and December 2015, we have analyzed the clinical outcomes of 22 primary total knee replacements and 21 ORIFs. The mean follow-up was 27 months. The intra- and postoperative complications, as well as the knee society score (KSS), were our outcome measures. The knee range of motion and the KSS knee and function scores were significantly better in the TKA patients compared with ORIF patients. Early postoperative full weight-bearing was allowed in the TKA patients with lower complications rate. In conclusion, primary TKA utilizing a stemmed tibial component is an effective treatment option for elderly patients with a complex acute fracture of the tibial plateau. This is a Type III therapeutic study.
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