title: Does short-term application of an Ilizarov frame with transfixion pins correct relapsed clubfoot in children?
abstract: BACKGROUND
  Treatment of relapsed clubfoot after soft tissue release in children is difficult because of the high recurrence rate and related complications. Even though the Ilizarov method is used for soft tissue distraction, there is a high incidence of recurrence after removal of the Ilizarov frame owing to previous contracture of soft tissue and a skin scar.
  
  
  OBJECTIVE
  We asked (1) whether transfixation of midfoot joints by temporary K wires during the consolidation stage after short-term application of an Ilizarov frame would maintain correction of the relapsed clubfoot clinicoradiologically and (2) whether this method would reduce the rate of recurrence and related complications in patients with a skin scar from previous surgery.
  
  
  METHODS
  We retrospectively reviewed 18 patients (19 feet) with relapsed clubfeet who underwent correction by soft tissue distraction using an Ilizarov ring fixator, between March 2005 and June 2008. The mean age of the patients was 8 ± 2 years (range, 4-15 years). K wire fixation for the midfoot joints combined with a below-knee cast were used during the consolidation stage. The minimum followup was 2 years (mean, 4.5 years; range, 2-6 years).
  
  
  RESULTS
  The average duration of frame application was 5 weeks; the mean duration of treatment was 11 weeks. At last followup, 16 of 19 feet were painless and plantigrade and only three of 19 feet had recurrence. The mean preoperative clinical American Foot and Ankle Society (AOFAS) score had increased at last followup (57 versus 81). The values of the AP talocalcaneal, AP talo-first metatarsal, and lateral calcaneo-first metatarsal angles improved after treatment. The three recurrent clubfeet were treated by corrective osteotomies and Ilizarov frame application.
  
  
  CONCLUSIONS
  This method could maintain the correction of relapsed clubfoot in children and reduce the recurrence rate and complications regardless of the presence of a skin scar owing to previous surgery.
authors.affiliation: Department of Orthopaedic Surgery, Institute for Rare Diseases, Guro Hospital, Korea University Medical College, 80 Guro-Dong, Guro-Gu, Seoul, 152-703, Korea.
authors.forename: Mohamed Ahmed
authors.initials: MA
authors.lastname: Refai
authors.forename: Sang-Heon
authors.initials: SH
authors.lastname: Song
authors.forename: Hae-Ryong
authors.initials: HR
authors.lastname: Song
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004867:Equipment Design; D016267:External Fixators; D005260:Female; D006801:Humans; D018889:Ilizarov Technique / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D011859:Radiography; D020127:Recovery of Function; D012008:Recurrence; D012086:Reoperation; D056910:Republic of Korea; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome