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Dong W, Shi N, Wen C, Zhang Y. An investigation of maternal psychological status of children with congenital talipes equinovarus treated with the Ponseti method. J Child Orthop 2023; 17:184-190. [PMID: 37034198 PMCID: PMC10080240 DOI: 10.1177/18632521221145479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/23/2022] [Indexed: 01/07/2023] Open
Abstract
Objectives: To investigate maternal psychological status of children with congenital talipes equinovarus in different periods, and to clarify the influence on maternal psychological status of congenital talipes equinovarus treated with the Ponseti method. Methods: Sixty-seven mothers of children with congenital talipes equinovarus were investigated. Self-rating Depression Scale and Self-rating Anxiety Scale were used to evaluate the psychological stress of the mothers at different periods. Paired-samples t-test was used to analyze the results. Results: The mothers of 67 children with congenital talipes equinovarus ranged from 25 to 38 years old, with an average of 33.5 years old. Before prenatal diagnosis of congenital talipes equinovarus, the average score of Self-rating Anxiety Scale was 42.537 ± 10.476, and the average score of Self-rating Depression Scale was 47.254 ± 12.846; after prenatal diagnosis of congenital talipes equinovarus, the average score of Self-rating Anxiety Scale was 54.224 ± 13.050, and the average score of Self-rating Depression Scale was 57.403 ± 13.649 points. Before the postpartum treatment of congenital talipes equinovarus, the average score of Self-rating Anxiety Scale was 53.388 ± 12.716, the average score of Self-rating Depression Scale was 56.284 ± 13.617; after the treatment of congenital talipes equinovarus with the Ponseti method, the average score of Self-rating Anxiety Scale was 47.731 ± 12.259, and the average score of Self-rating Depression Scale was 51.910 ± 13.878 points. The above differences were statistically significant (P < 0.001). Conclusion: The prenatal diagnosis of congenital talipes equinovarus will increase the maternal psychological stress, and the maternal psychological status will be significantly improved after the deformity of congenital talipes equinovarus is corrected effectively by the Ponseti method. Level of evidence: level III, retrospective study.
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Affiliation(s)
- Wentao Dong
- Department of Orthopaedics, Shenzhen
University General Hospital, Shenzhen, P.R. China
| | - Ningning Shi
- Department of Operating Room and
Anesthesia, Shenzhen University General Hospital, Shenzhen, P.R. China
| | - Chunyu Wen
- Department of Orthopaedics, Shenzhen
University General Hospital, Shenzhen, P.R. China
| | - Yong Zhang
- Department of Orthopaedics, Shenzhen
University General Hospital, Shenzhen, P.R. China
- Yong Zhang, Department of Orthopaedics,
Shenzhen University General Hospital, Shenzhen 518055, P.R. China.
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2
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Hopwood S, Khan F, Kemp J, Rehm A, Ashby E. Clubfoot: an overview and the latest UK guidelines. Br J Hosp Med (Lond) 2023; 84:1-7. [PMID: 36708340 DOI: 10.12968/hmed.2022.0380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Clubfoot is one of the most common congenital anomalies, affecting every 1 of 1000 live births in the UK. Historically, clubfeet have been managed with a variety of conservative and operative techniques. Over the last two decades, the Ponseti serial casting method has become the gold standard of treatment. In July 2021, the British Society of Children's Orthopaedic Surgery (Gelfer et al, 2022) published a consensus statement that outlines the optimal management for clubfoot. This article provides an overview of clubfoot and a summary of the latest management guidelines.
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Affiliation(s)
- Samuel Hopwood
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
| | | | - Jennifer Kemp
- Department of Paediatric Trauma and Orthopaedic Physiotherapy, Addenbrooke's Hospital, Cambridge, UK
| | - Andreas Rehm
- Department of Paediatric Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
| | - Elizabeth Ashby
- Department of Paediatric Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
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3
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Outcome of prenatal diagnosis of clubfoot: a single institution experience. Future Sci OA 2022; 8:FSO773. [PMID: 35070355 PMCID: PMC8765115 DOI: 10.2144/fsoa-2021-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
Aim: To assess the accuracy of antenatal diagnosis of clubfoot (CF), risk factors and outcomes in postnatal. Patients & methods: Maternal characteristics, sonographic signs and postnatal outcomes were evaluated in 60 patients with a prenatal diagnosis of CF between 2007 and 2020. Results: The rate of antenatal diagnosis of CF was 3.72/1000 live births. The false-positive rate was 6.67%. 66.7% of fetuses had bilateral CF and 33.3% had unilateral CF; 58.3% were isolated and 41.7% were complex; 58.3% were males and 41.7% were female; 16.7% were multiple pregnancies and 10% were cases of consanguinity. Conclusion: The accuracy of the diagnosis of CF depends on the operator’s skills. A significant relationship is demonstrated between the interruption of pregnancy, consanguinity, laterality and complexity. CF is one of the most common fetal anomalies detected antenatally on ultrasound, occurring in approximately 1/1000 live births. We present our single institution experience with the antenatal diagnosis of CF. Over 60 cases, the rate of prenatal diagnosis of CF was 3.72/1000 live births; of which 33.3% had unilateral CF; 58.3% were isolated and 41.7% were complex; 58.3% were males and 41.7% were female; 16.7% were multiple pregnancies and 10% were cases of consanguinity.
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4
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Aparisi Gómez MP, Watkin S, Perry D, Simoni P, Trisolino G, Bazzocchi A. Anatomical Considerations of Embryology and Development of the Musculoskeletal System: Basic Notions for Musculoskeletal Radiologists. Semin Musculoskelet Radiol 2021; 25:3-21. [PMID: 34020465 DOI: 10.1055/s-0041-1723005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The musculoskeletal (MSK) system begins to form in the third week of intrauterine development. Multiple genes are involved in the complex different processes to form the skeleton, muscles and joints. The embryonic period, from the third to the eighth week of development, is critical for normal development and therefore the time when most structural defects are induced. Many of these defects have a genetic origin, but environmental factors may also play a very important role. This review summarizes the embryology of the different components of the MSK system and their configuration as an organ-system, analyzes the clinical implications resulting from failures in the process of organogenesis, and describes the first approach to diagnosis of skeletal abnormalities using prenatal ultrasound.
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Affiliation(s)
- Maria Pilar Aparisi Gómez
- Department of Radiology, National Women's Ultrasound, Auckland City Hospital, Auckland, New Zealand.,Department of Radiology, Hospital Vithas Nueve de Octubre, Valencia, Spain
| | - Sheryl Watkin
- Department of Radiology, National Women's Ultrasound, Auckland City Hospital, Auckland, New Zealand
| | - David Perry
- Department of Radiology, National Women's Ultrasound, Auckland City Hospital, Auckland, New Zealand.,Department of Pediatric Radiology, Starship Children's Hospital, Auckland City Hospital, Auckland, New Zealand
| | - Paolo Simoni
- Diagnostic Imaging Department, Université Libre de Bruxelles, "Reine Fabiola" Children's University Hospital, Bruxelles, Belgium
| | - Giovanni Trisolino
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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5
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Birrer E, Morovic M, Fernández P. PIE BOT: CONCEPTOS ACTUALES. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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6
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Abstract
PURPOSE OF REVIEW This review aims to provide primary care physicians with updates on recent literature regarding clubfoot and answer questions asked by parents and caregivers of children with clubfoot. The topics discussed include prenatal counseling, relapse after Ponseti treatment, long-term outcomes following successful treatment of clubfoot, and the effect of diagnosis and treatment on the parent or caregiver. RECENT FINDINGS Clubfoot is one of the most commonly searched orthopaedic conditions on the internet by parents. There is a lack of evidence-based guidelines on clubfoot worldwide. Recent systematic reviews have identified emerging evidence of genetic and modifiable risk factors that lead to clubfoot. Patients treated by the Ponseti method show better ankle power and strength compared with those treated with surgery for residual deformity or recurrence. SUMMARY The treatment of clubfoot is a long and involved process. Exposure to and familiarity with the Ponseti method will aid primary care physicians and parents in the optimization of children's clubfoot deformity correction using largely nonoperative management.
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Affiliation(s)
| | - Shevaun M Doyle
- Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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7
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Farr A, Wachutka E, Bettelheim D, Windsperger K, Farr S. Perinatal outcomes of infants with congenital limb malformations: an observational study from a tertiary referral center in Central Europe. BMC Pregnancy Childbirth 2020; 20:35. [PMID: 31931744 PMCID: PMC6958570 DOI: 10.1186/s12884-020-2720-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/03/2020] [Indexed: 01/03/2023] Open
Abstract
Background Congenital limb malformations are rare, and their perinatal outcomes are not well described. This study analyzed the perinatal outcomes of infants with congenital limb malformations. Methods All infants with congenital limb malformations who underwent prenatal assessment and delivery at our tertiary referral center from 2004 through 2017 were retrospectively identified. Neonatal outcome parameters were assessed, and the predictors of worse perinatal outcomes were determined. Results One hundred twenty-four cases of congenital limb malformations were identified, of which 104 (83.9%) were analyzed. The upper limb was affected in 15 patients (14.4%), the lower limb in 49 (47.1%), and both limbs in 40 (38.5%) patients. A fetal syndrome was identified in 66 patients (63.5%); clubfoot and longitudinal reduction defects were the most frequent malformations. In total, 38 patients (36.5%) underwent termination, seven (6.7%) had stillbirth, and 59 (56.7%) had live-born delivery. Rates of preterm delivery and transfer to the Neonatal Intensive Care Unit were 42.4 and 25.4%, respectively. Localization of the malformation was a determinant of perinatal outcome (P = .006) and preterm delivery (P = .046). Conclusions Congenital limb malformations frequently occur bilaterally and are associated with poor perinatal outcomes, including high rates of stillbirth and preterm delivery. Multidisciplinary care and referral to a perinatal center are warranted.
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Affiliation(s)
- Alex Farr
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| | - Eva Wachutka
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Dieter Bettelheim
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Karin Windsperger
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Sebastian Farr
- Department of Pediatric Orthopedics and Adult Foot and Ankle Surgery, Orthopedic Hospital Speising, Vienna, Austria
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8
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Di Mascio D, Buca D, Khalil A, Rizzo G, Makatsariya A, Sileo F, Liberati M, Benedetti Panici P, Acharya G, D'Antonio F. Outcome of isolated fetal talipes: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2019; 98:1367-1377. [PMID: 31034582 DOI: 10.1111/aogs.13637] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/16/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The aim of this systematic review was to explore the outcome of fetuses with a prenatal diagnosis of isolated talipes. MATERIAL AND METHODS Medline, Embase, Cinahl, and Clinicaltrials.gov databases were searched. The outcomes explored were: associated anomalies detected at follow-up ultrasound examination; fetal magnetic resonance imaging (MRI) and birth; chromosomal abnormalities detected with standard and chromosomal microarray analysis, intrauterine, neonatal, and perinatal death, and termination of pregnancy; rate of surgical and nonsurgical treatment; neurodevelopmental outcome; and false-positive rate of prenatal diagnosis. Meta-analyses of proportions were used to combine data. RESULTS Twenty-five studies (1567 fetuses) were included. Associated anomalies were detected in 7.8% (95% CI 0.1%-29.3%) of cases at follow-up ultrasound, and in 4.0% (95% CI 0.1%-13.2%) of cases, fetal MRI identified anomalies not detected at ultrasound assessment. Similarly, 7.0% (95% CI 3.4%-11.7%) of cases labeled as isolated talipes on prenatal imaging were found to have associated anomalies at birth. Abnormal karyotype was present in 3.6% (95% CI 1.7%-6.2%) of fetuses, whereas no anomaly was found at chromosomal microarray analysis, although this outcome was reported by only 1 study. Intrauterine death occurred in 0.99% (95% CI 0.4%-1.9%) of fetuses, whereas the corresponding figures for neonatal death and termination of pregnancy were 1.5% (95% CI 0.6%-2.6%) and 2.2% (95% CI 1.2%-3.4%), respectively. Surgical management of anomalies after birth was found in 41.7% (95% CI 27.0%-57.2%) of fetuses with isolated talipes, and 54.8% (95% CI 31.5%-77.0%) had nonsurgical management of the anomalies after birth. Abnormal neurodevelopmental outcome was reported in 7.6% (95% CI 1.0%-19.4%) of children, although this analysis was affected by the small number of included cases and short time of follow up. CONCLUSIONS Isolated talipes detected on prenatal ultrasound carries a generally good prognosis. The incidence of additional abnormalities detected on fetal MRI, aneuploidy, or neurodevelopmental disability is relatively low. However, longitudinal ultrasound assessment during pregnancy and a thorough postnatal evaluation are recommended to rule out associated anomalies that may significantly impact short- and long-term prognosis.
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Affiliation(s)
- Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Rome, Italy
| | - Danilo Buca
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Saint George's Hospital, London, UK
- Vascular Biology Research Center, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Giuseppe Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alexander Makatsariya
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Filomena Sileo
- Fetal Medicine Unit, Saint George's Hospital, London, UK
| | - Marco Liberati
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | | | - Ganesh Acharya
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Francesco D'Antonio
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø, Norway
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9
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Abstract
PURPOSE The presence of a clubfoot is often found prenatally and some families seek counselling with a specialist. The purpose of this study was to compare the parental anxiety levels in families that: a) knew prenatally and had prenatal counselling; b) knew prenatally but did not seek prenatal counselling; and c) did not know until after delivery. METHODS This prospective cohort study evaluated the anxiety of parents as they presented to the paediatric orthopaedic clinic with their newborn with a foot disorder (prior to the diagnostic confirmation of clubfoot). Each family filled out the 'Pre-visit orthopaedic surgeon questionnaire' and then after the initial visit with the orthopaedic surgeon (confirming the clubfoot diagnosis) the family filled out the 'Immediately post-visit orthopaedic surgeon questionnaire'. Through these questionnaires, anxiety level was assessed prior to meeting postnatally with the paediatric orthopaedic specialist, as well as after the meeting and compared across groups. RESULTS A total of 121 parents completed questionnaires: 71% (86/121) confirmed clubfoot; 69% of families (59/86) received prenatal counselling (Group A); 16% (14/86) knew prenatally but had no counselling (Group B); and 15% (13/86) found out at birth (Group C). There was no difference in anxiety levels across groups before (p = 0.78) or after (p = 0.57) meeting with the paediatric orthopaedic surgeon; however, overall anxiety reduced significantly (p < 0.001). CONCLUSION We found no difference in the anxiety levels of across the three groups. Prenatal counselling for parents of children with likely clubfoot may not decrease parental anxiety, but nonetheless is very appreciated by the families who receive it. LEVEL OF EVIDENCE Prognostic Level II.
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Affiliation(s)
- S. T. Mahan
- Department of Orthopaedics Boston Children’s Hospital Boston Massachusetts, USA,Harvard Medical School Boston Massachusetts, USA,Correspondence should be sent to S. T. Mahan, Department of Orthopaedics, Boston Children’s Hospital, 300 Longwood Ave, Boston MA 02115, USA.
| | - P. E. Miller
- Department of Orthopaedics Boston Children’s Hospital Boston Massachusetts, USA
| | - C. J. May
- Department of Orthopaedics Boston Children’s Hospital Boston Massachusetts, USA,Harvard Medical School Boston Massachusetts, USA
| | - J. R. Kasser
- Department of Orthopaedics Boston Children’s Hospital Boston Massachusetts, USA,Harvard Medical School Boston Massachusetts, USA
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Razavi AS, Chasen ST, Coombs S, Kalish RB. Diagnostic accuracy of isolated clubfoot in twin compared to singleton gestations. J Perinat Med 2019; 47:564-567. [PMID: 31091196 DOI: 10.1515/jpm-2018-0231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 03/21/2019] [Indexed: 11/15/2022]
Abstract
Background Our objective was to determine the predictive value of the prenatal diagnosis of isolated clubfoot in twin gestations compared to singleton gestations. Methods A prospectively entered ultrasound database was reviewed for all pregnancies scanned at our institution from 2002 to 2014. Cases of suspected clubfoot were identified. Neonates with associated anomalies or aneuploidy, and patients who delivered at other institutions were excluded. Neonatal charts were reviewed for the confirmation of clubfoot. The chi-squared (χ2) test, Fisher's exact test and the Mann-Whitney U test were used in the analysis, with p < 0.05 considered significant. Results Of those women who had prenatal ultrasound and subsequently delivered at our hospital, 84 pregnancies had isolated clubfoot suspected in the antenatal period. Of these pregnancies, 20 were twin gestations and 64 were singleton gestations. Overall, 51/84 (60.7%) pregnancies had clubfoot confirmed during the neonatal period. Of the twin pregnancies, only 35% (7/20) had a confirmed diagnosis of clubfoot at birth compared to 68.8% (44/64) of the singleton pregnancies (P = 0.008). Gestational age at diagnosis, breech presentation, neonatal gender, unilateral vs. bilateral clubfoot and suspicion of clubfoot in the presenting twin (Twin A) vs. the non-presenting twin (Twin B) did not correlate with an accurate diagnosis of clubfoot in twins. Conclusion False-positive prenatal diagnosis of isolated clubfoot is more common in twin gestations compared to singletons. This may be due to transient malpositioning or a result of diminished space. Obstetric providers should consider the possibility of a false-positive diagnosis and use caution when counseling patients about a prenatal suspicion for clubfoot, especially in twin gestations.
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Affiliation(s)
- Armin S Razavi
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Stephen T Chasen
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Shannon Coombs
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Robin B Kalish
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Weill Cornell Medical College, New York, NY 10065, USA
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11
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Abstract
BACKGROUND Clubfoot is a common congenital anomaly with multiple potential risk factors. Identification of modifiable risk factors may minimize future incidence of clubfoot. The aim of this meta-analysis was to systematically review and analyze the best clinical evidence regarding risk factors associated with clubfoot. METHODS Medline, Embase, and Cochrane databases were systematically searched from 1967 to May 11, 2016 for studies reporting risk factors for clubfoot. Randomized trials and observational studies were eligible for inclusion, and assessed in duplicate. Study quality was assessed with the Newcastle-Ottawa Scale or Cochrane risk of bias tool; low quality studies were excluded, all randomized trials were included. Two reviewers extracted data independently. This meta-analysis was conducted in accordance with PRISMA guidelines. Pooled effect estimates for the odds of clubfoot were calculated using random or fixed-effects models based on heterogeneity. RESULTS Forty-two studies (28 case-control, 10 cohort, 4 randomized trials) comprising 31,844 clubfoot cases and 6,604,013 controls were included. Risk factors associated with increased odds of clubfoot included maternal smoking [odds ratio (OR)=1.65; 95% confidence interval (CI), 1.54-1.78], paternal smoking (OR=1.72; 95% CI, 1.05-2.84), maternal body mass index >30 (OR=1.46; 95% CI, 1.29-1.65), family history (OR=7.80; 95% CI, 4.04-15.04), amniocentesis (OR=2.08; 95% CI, 1.34-3.21), selective serotonin reuptake inhibitor exposure (OR=1.78; 95% CI, 1.34-2.37) maternal single status (OR=1.17; 95% CI, 1.11-1.23), gestational diabetes (OR=1.40; 95% CI, 1.13-1.72), nulliparity (OR=1.32; 95% CI, 1.19-1.45), male sex (OR=1.68; 95% CI, 1.48-1.94), and aboriginal Australian race (OR=2.35; 95% CI, 1.63-3.38). CONCLUSIONS Smoking, maternal obesity, family history, amniocentesis, and some selective serotonin reuptake inhibitor exposures are the most clinically relevant exposures associated with increased odds of clubfoot, with family history representing the greatest risk. Recognition of modifiable risk factors may help in counseling patients, and minimizing clubfoot incidence. LEVEL OF EVIDENCE Level II.
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12
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Kadia BM, Aroke D, Tianyi FL, Bechem NN, Dimala CA. Spina bifida cystica and severe congenital bilateral talipes equinovarus in one twin of a monoamniotic pair: a case report. BMC Res Notes 2017; 10:771. [PMID: 29282147 PMCID: PMC5745804 DOI: 10.1186/s13104-017-3108-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/20/2017] [Indexed: 09/15/2023] Open
Abstract
Background Spina bifida and congenital talipes equinovarus (CTEV) are common congenital malformations which may occur together and increase morbidity. Monozygous twins are particularly at risk of these malformations and discordance in one type of malformation is typical. The occurrence of both spina bifida and CTEV in one twin of a monozygotic pair is rare. Case presentation A 22 year-old Cameroonian primigravida at 36 weeks of a twin gestation was received in our district hospital at the expulsive phase of labour on a background of sub-optimal antenatal care. A caesarean section indicated for cephalo-pelvic disproportion was performed and life monoamniotic male twins were extracted. The first twin was normal. The second twin had spina bifida cystica and severe bilateral CTEV. Routine postnatal care was ensured and at day 2 of life, the affected twin was evacuated to a tertiary hospital for proper management. He was later on reported dead from complications of hydrocephalus. Conclusions Spina bifida cystica with severe bilateral CTEV in one twin of a monoamniotic pair illustrates the complexity in the interplay of causal factors of these malformations even among monozygotic twins who are assumed to share similar genetic and environmental features. The occurrence and poor outcome of the malformations was probably potentiated by poor antenatal care. With postnatal diagnoses, a better outcome was difficult to secure even with prompt referral. Early prenatal diagnoses and appropriate counseling of parents are cardinal.
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Affiliation(s)
- Benjamin Momo Kadia
- Foumbot District Hospital, Foumbot, Cameroon.,Grace Community Health and Development Association, Kumba, Cameroon
| | - Desmond Aroke
- Health and Human Development (2HD) Research Network, Douala, Cameroon. .,Mbengwi District Hospital, Mbengwi, Cameroon.
| | | | | | - Christian Akem Dimala
- Health and Human Development (2HD) Research Network, Douala, Cameroon.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Orthopaedics, Southend University Hospital, Essex, UK
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13
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Abstract
BACKGROUND Idiopathic clubfoot is bilateral in approximately 50% of cases and has been widely reported to affect males more frequently than females. Despite these observations, the correlation between sex and severity of the deformity has not been established. As well, the difference in severity between unilateral and bilateral clubfeet has not been extensively investigated. Therefore, the goals of the present study were to: (1) examine the relationship between sex and severity of deformity and (2) determine the relationship between laterality and severity of deformity. METHODS The families of infants with idiopathic clubfoot deformity treated at our institution were prospectively invited to participate in this institutional review board-approved study. Severity of the deformity was assessed by a single surgeon for each patient using the Dimeglio criteria at the first clinic visit. After evaluating the distributions, the correlations were quantified by nonparametric analyses. RESULTS Over 8 years, 240 infants met the inclusion criteria. There was no significant difference in the severity of deformity due to sex (P=0.61): the median Dimeglio score for males was 13 (variance 4.8) and for females, the median was 13.0 (variance of 5.1). In contrast, severity was distributed differently among unilateral versus bilateral patients. Although both unilateral and bilateral patients had a median Dimeglio score of 13, the ratio of bilateral patients was higher among those with moderate or very severe deformities compared with those with severe deformities (P<0.01). CONCLUSIONS Although idiopathic clubfoot is commonly considered to affect male patients disproportionately, this is the first study to document no difference in severity due to sex. Further, this study demonstrated that on average, bilateral patients did not have increased severity, but presented with a larger range of severity than those patients with unilateral deformity. LEVEL OF EVIDENCE Level III-prognostic.
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14
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Granite G, Herzenberg JE, Wade R. Rare case of tibial hemimelia, preaxial polydactyly, and club foot. World J Clin Cases 2016; 4:401-408. [PMID: 28035313 PMCID: PMC5156877 DOI: 10.12998/wjcc.v4.i12.401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/05/2016] [Accepted: 09/22/2016] [Indexed: 02/05/2023] Open
Abstract
A seven-month old female presented with left tibial hemimelia (or congenital tibial aplasia; Weber type VIIb, Jones et al type 1a), seven-toed preaxial polydactyly, and severe club foot (congenital talipes equinovarus). Definitive amputation surgery disarticulated the lower limb at the knee. This case report describes the anatomical findings of a systematic post-amputation examination of the lower limb’s superficial dissection, X-rays, and computed tomography (CT) scans. From the X-rays and CT scans, we found curved and overlapping preaxial supernumerary toes, hypoplastic first metatarsal, lack of middle and distal phalanges in one supernumerary toe, three tarsal bones, hypoplastic middle phalanx and no distal phalanx for fourth toe, and no middle or distal phalanges for fifth toe. The fibula articulated with the anteromedial calcaneus and the tibia was completely absent. We identified numerous muscles and nerves in the superficial dissection that are described in the results section of the case report. Due to the rarity of this combination of anatomical findings, descriptions of such cases are very infrequent in the literature.
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Huntley JS, Howard JJ. QUESTION 2: What is the predictive value of an antenatal ultrasound showing apparently isolated talipes equinovarus? Arch Dis Child 2016; 101:1073-1078. [PMID: 28245180 DOI: 10.1136/archdischild-2016-311594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/21/2016] [Indexed: 11/03/2022]
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Liu Y, Zhao D, Zhao L, Li H, Yang X. Congenital Clubfoot: Early Recognition and Conservative Management for Preventing Late Disabilities. Indian J Pediatr 2016; 83:1266-1274. [PMID: 26341712 DOI: 10.1007/s12098-015-1860-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/22/2015] [Indexed: 12/11/2022]
Abstract
Congenital clubfoot is one of the most common musculoskeletal deformities presenting at birth. Many high risk factors have been associated with clubfoot such as male gender, primiparous mothers and maternal smoking. Accurate understanding of clubfoot pathoanatomy is supposed to be the basis for deformity correction. Prenatal ultrasonography is of reference value in recognizing clubfoot during pregnancy. Neglected clubfoot can eventually cause a noticeable disability and severely influence the quality life in adulthood. Early recognition and treatment are presumed to be the key for prevention of late disabilities. Nowadays, Ponseti method, as one of the conservative treatment regimen, has been widely accepted because of the reported good results of long-term follow-up. However, special attention should be paid to the details in clinical practice for achieving even better correction and a lower rate of relapse. After the complete correction, brace wearing is critical for preventing deformity relapse. Non-compliance or non-adherence with the brace protocol has been considered as the predominant risk factor predisposing to the relapse of clubfoot, which is still a challenging problem. This paper was prepared to give a general introduction about clubfoot, in terms of the importance of early recognition and conservative management, especially Ponseti method, for preventing late disabilities.
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Affiliation(s)
- Yubin Liu
- Department of Pediatric Orthopedics, Xin-Hua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Dahang Zhao
- Department of Pediatric Orthopedics, Xin-Hua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China.,The Third Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Street, Harbin, 150001, Heilongjiang Province, China
| | - Li Zhao
- Department of Pediatric Orthopedics, Xin-Hua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China.
| | - Hai Li
- Department of Pediatric Orthopedics, Xin-Hua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Xuan Yang
- Department of Pediatric Orthopedics, Xin-Hua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China
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Viaris de le Segno B, Gruchy N, Bronfen C, Dolley P, Leporrier N, Creveuil C, Benoist G. Prenatal diagnosis of clubfoot: Chromosomal abnormalities associated with fetal defects and outcome in a tertiary center. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:100-105. [PMID: 26179848 DOI: 10.1002/jcu.22275] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 11/30/2014] [Accepted: 12/26/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE Our aim was to evaluate the rate of occurrence of chromosomal abnormalities, associated findings, and outcome in a series of cases of prenatally diagnosed clubfoot. METHODS We conducted a retrospective study of all cases of clubfoot diagnosed prenatally in the ultrasound unit of a French tertiary center from January 2004 through December 2011. Clubfoot was scored as complex or isolated depending on the presence or absence of another structural abnormality observed on sonographic examination. RESULTS Data from 90 fetuses prenatally diagnosed with clubfoot were included in this study. Thirty-four cases were considered complex (38%) and 56 were considered isolated (62%). A chromosomal abnormality was identified in 10 of 33 of the fetuses with complex clubfoot and in 1 of 45 of those with isolated clubfoot (p < 0.001). Clubfoot was associated with a poor outcome in 5 of 52 cases of isolated clubfoot and in 31 of 34 cases associated with other structural defects (p < 0.001). The deformity was bilateral in 62 cases (69%) and unilateral in 28 (31%). No statistically significantly higher rate of poor outcome was identified when the deformity occurred bilaterally nor was a significantly higher rate of chromosomal abnormality noted in this condition. CONCLUSIONS Aneuploidy and adverse pregnancy outcomes occur more commonly in prenatally diagnosed cases of complex clubfoot than in those of isolated clubfoot. Fetal karyotyping is required in cases of complex clubfoot, but the need for that procedure in isolated clubfoot remains controversial.
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Affiliation(s)
- Benjamin Viaris de le Segno
- CHU de Caen, Département d'Obstétrique, Gynécologie et Médecine de la Reproduction, Caen, 14000, France
- CHU de Caen, Département de Statistiques, Avenue Clémenceau, 14033 Caen Cedex 9, France
| | - Nicolas Gruchy
- CHU de Caen, Département de Statistiques, Avenue Clémenceau, 14033 Caen Cedex 9, France
- CHU de Caen, Département de Cytogénétique Prénatale, Caen, 14000, France
| | - Corinne Bronfen
- CHU de Caen, Département d'Orthopédie Pédiatrique, 14033 Caen Cedex 9, France
| | - Patricia Dolley
- CHU de Caen, Département d'Obstétrique, Gynécologie et Médecine de la Reproduction, Caen, 14000, France
| | - Nathalie Leporrier
- CHU de Caen, Département de Statistiques, Avenue Clémenceau, 14033 Caen Cedex 9, France
- CHU de Caen, Département de Cytogénétique Prénatale, Caen, 14000, France
| | - Christian Creveuil
- CHU de Caen, Département de Statistiques, Avenue Clémenceau, 14033 Caen Cedex 9, France
- Université de Caen Basse-Normandie, Esplanade de la Paix, 14032 Caen Cedex 5, France
| | - Guillaume Benoist
- CHU de Caen, Département d'Obstétrique, Gynécologie et Médecine de la Reproduction, Caen, 14000, France
- CHU de Caen, Département de Statistiques, Avenue Clémenceau, 14033 Caen Cedex 9, France
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Abstract
Ultrasonography is a safe, cost-effective tool used to prenatally detect common musculoskeletal conditions, including clubfoot, skeletal dysplasias, limb-length discrepancies, spinal abnormalities, and hand and other upper extremity deformities. With increased detection of such abnormalities, prenatal parental counseling by orthopaedic surgeons is being requested more frequently. Counseling is important for family education on prognosis and treatment options. A thorough understanding of the common musculoskeletal conditions diagnosed on prenatal ultrasonography, classification of these conditions, and the correlations of these classifications to postnatal severity allows the orthopaedic surgeon to conduct well-informed counseling sessions with families. Accurate information and counseling aids parents in understanding their child's diagnosis, assists clinicians in planning treatment algorithms, and optimizes family preparedness.
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Khodja Bach S, Houfflin-Debarge V, Vaast P, Wapler C, Coulon C. [Clubfoot's prenatal ultrasound diagnosis: is amniocentesis always warranted? About 124 cases]. ACTA ACUST UNITED AC 2015; 43:117-22. [PMID: 25637038 DOI: 10.1016/j.gyobfe.2014.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 12/15/2014] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Analyze factors leading to isolated clubfoot's occurrence, identify clubfeet associated pathologies, and discuss the opportunity of performing an amniocentesis in cases of isolated clubfoot. PATIENTS AND METHODS Between January 2007 and December 2011, all patients diagnosed with clubfoot in our prenatal diagnostic center were retrospectively included. We then defined and analyzed idiopathic or isolated talipses equinovarus (ITEV) and clubfeet associated with others morphologic abnormalities or syndromic talipses equinovarus (STEV). RESULTS One hundred and twenty-four clubfeet were analyzed. Forty-seven cases of ITEV, for which 34 caryotypes were performed with a normal result. Risk factors of ITEV in our series were male gender (P=0.0017), a family history of clubfoot (P=0.001) and primiparity (P=0.04). Seventy-seven cases of STEV were diagnosed, 14 of which had chromosomal abnormalities, 18 spina bifida and 10 musculo-skeletal abnormalities. Among the 124 cases of clubfeet, 25 were unilateral and 99 were bilateral. Bilateral talipses equinovarus do not constitute a risk factor of STEV (P=0.8). DISCUSSION AND CONCLUSION We did not find any chromosomic abnormalities in cases of ITEV. The results of our study could lead to defer systematic amniocentesis in cases of primiparous women diagnosed with an ITEV, with a familial history of clubfoot and a male fetus. A referent echographist in prenatal diagnosis should still perform a systematic morphologic echography.
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Affiliation(s)
- S Khodja Bach
- Pôle femme-mère-nouveau-né, hôpital Jeanne-de-Flandre, université Lille-Nord-de-France, CHRU de Lille, 59000 Lille, France.
| | - V Houfflin-Debarge
- Pôle femme-mère-nouveau-né, hôpital Jeanne-de-Flandre, université Lille-Nord-de-France, CHRU de Lille, 59000 Lille, France
| | - P Vaast
- Pôle femme-mère-nouveau-né, hôpital Jeanne-de-Flandre, université Lille-Nord-de-France, CHRU de Lille, 59000 Lille, France
| | - C Wapler
- Clinique d'orthopédie B, hôpital Roger-Salengro, CHRU de Lille, boulevard Émile-Laine, 59045 Lille cedex, France
| | - C Coulon
- Pôle femme-mère-nouveau-né, hôpital Jeanne-de-Flandre, université Lille-Nord-de-France, CHRU de Lille, 59000 Lille, France
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Toufaily MH, Westgate MN, Holmes LB. Congenital talipes equinovarus: frequency of associated malformations not identified by prenatal ultrasound. Prenat Diagn 2014; 35:254-7. [DOI: 10.1002/pd.4534] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 11/06/2014] [Accepted: 11/07/2014] [Indexed: 11/10/2022]
Affiliation(s)
- M. Hassan Toufaily
- Medical Genetics Unit, MassGeneral Hospital for Children, Department of Pediatrics; Harvard Medical School; Boston MA USA
| | - Marie-Noel Westgate
- Medical Genetics Unit, MassGeneral Hospital for Children, Department of Pediatrics; Harvard Medical School; Boston MA USA
| | - Lewis B. Holmes
- Medical Genetics Unit, MassGeneral Hospital for Children, Department of Pediatrics; Harvard Medical School; Boston MA USA
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Delpont M, Lafosse T, Bachy M, Mary P, Alves A, Vialle R. [Congenital foot abnormalities]. Arch Pediatr 2014; 22:331-6. [PMID: 25524290 DOI: 10.1016/j.arcped.2014.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/04/2014] [Accepted: 11/14/2014] [Indexed: 11/25/2022]
Abstract
The foot may be the site of birth defects. These abnormalities are sometimes suspected prenatally. Final diagnosis depends on clinical examination at birth. These deformations can be simple malpositions: metatarsus adductus, talipes calcaneovalgus and pes supinatus. The prognosis is excellent spontaneously or with a simple orthopedic treatment. Surgery remains outstanding. The use of a pediatric orthopedist will be considered if malposition does not relax after several weeks. Malformations (clubfoot, vertical talus and skew foot) require specialized care early. Clubfoot is characterized by an equine and varus hindfoot, an adducted and supine forefoot, not reducible. Vertical talus combines equine hindfoot and dorsiflexion of the forefoot, which is performed in the midfoot instead of the ankle. Skew foot is suspected when a metatarsus adductus is resistant to conservative treatment. Early treatment is primarily orthopedic at birth. Surgical treatment begins to be considered after walking age. Keep in mind that an abnormality of the foot may be associated with other conditions: malposition with congenital hip, malformations with syndromes, neurological and genetic abnormalities.
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Affiliation(s)
- M Delpont
- Service de chirurgie orthopédique pédiatrique, université Pierre-et-Marie-Curie Paris 6, hôpital Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75571 Paris cedex 12, France.
| | - T Lafosse
- Service de chirurgie orthopédique pédiatrique, université Pierre-et-Marie-Curie Paris 6, hôpital Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75571 Paris cedex 12, France.
| | - M Bachy
- Service de chirurgie orthopédique pédiatrique, université Pierre-et-Marie-Curie Paris 6, hôpital Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75571 Paris cedex 12, France.
| | - P Mary
- Service de chirurgie orthopédique pédiatrique, université Pierre-et-Marie-Curie Paris 6, hôpital Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75571 Paris cedex 12, France.
| | - A Alves
- Service de chirurgie orthopédique pédiatrique, université Pierre-et-Marie-Curie Paris 6, hôpital Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75571 Paris cedex 12, France.
| | - R Vialle
- Service de chirurgie orthopédique pédiatrique, université Pierre-et-Marie-Curie Paris 6, hôpital Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75571 Paris cedex 12, France.
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Pullinger M, Southorn T, Easton V, Hutchinson R, Smith RP, Sanghrajka AP. An evaluation of prenatal ultrasound screening for CTEV: accuracy data from a single NHS University Teaching Hospital. Bone Joint J 2014; 96-B:984-8. [PMID: 24986955 DOI: 10.1302/0301-620x.96b.33444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Congenital Talipes Equinovarus (CTEV) is one of the most common congenital limb deformities. We reviewed the records of infants who had received treatment for structural CTEV between 1 January 2007 and 30 November 2012. This was cross-referenced with the prenatal scans of mothers over a corresponding period of time. We investigated the sensitivity, specificity, and positive and negative predictive values of the fetal anomaly scan for the detection of CTEV and explored whether the publication of Fetal Anomaly Screening Programme guidelines in 2010 affected the rate of detection. During the study period there were 95 532 prenatal scans and 34 373 live births at our hospital. A total of 37 fetuses with findings suggestive of CTEV were included in the study, of whom 30 were found to have structural CTEV at birth. The sensitivity of screening for CTEV was 71.4% and the positive predictive value was 81.1%. The negative predictive value and specificity were more than 99.5%. There was no significant difference between the rates of detection before and after publication of the guidelines (p = 0.5). We conclude that a prenatal fetal anomaly ultrasound screening diagnosis of CTEV has a good positive predictive value enabling prenatal counselling. The change in screening guidance has not affected the proportion of missed cases. This information will aid counselling parents about the effectiveness and accuracy of prenatal ultrasound in diagnosing CTEV.
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Affiliation(s)
- M Pullinger
- Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK
| | - T Southorn
- The Norfolk and Norwich University Hospitals NHS Foundation Trust, Department of Trauma & Orthopaedics, Colney Lane, Norwich, NR4 7UY, UK
| | - V Easton
- The Norfolk and Norwich University Hospitals NHS Foundation Trust, Department of Children's Physiotherapy, Colney Lane, Norwich, NR4 7UY, UK
| | - R Hutchinson
- The Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - R P Smith
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Department of Obstetrics & Gynaecology, Colney Lane, Norwich, NR4 7UY, UK
| | - A P Sanghrajka
- The Norfolk and Norwich University Hospitals NHS Foundation Trust, Department of Trauma & Orthopaedics, Colney Lane, Norwich, NR4 7UY, UK
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24
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Glotzbecker MP, Estroff JA, Curtis TA, Kalish LA, Spencer SA, Parad RB, Kasser JR, Mahan ST. Prospective Evaluation of a Prenatal Sonographic Clubfoot Classification System. Fetal Diagn Ther 2013; 34:236-40. [DOI: 10.1159/000354554] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 07/16/2013] [Indexed: 11/19/2022]
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Liao H, Cai A, Wang B, Wang X, Yan Z, Li J. Value of the fetal plantar shape in prenatal diagnosis of talipes equinovarus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:997-1002. [PMID: 22733848 DOI: 10.7863/jum.2012.31.7.997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the value of the fetal plantar shape in prenatal diagnosis of talipes equinovarus. METHODS A case-control study was conducted between September 2009 and February 2011. We measured the width and length of 249 feet (156 fetuses) included in this study and then calculated the width to length ratio. All of the fetuses were followed to obtain the pregnancy outcomes and confirm whether the deformity existed; then the bimalleolar angle of each foot with talipes equinovarus was measured. Independent samples t tests were performed to compare the foot width, length, and width to length ratio between normal and talipes equinovarus groups. We also assessed the correlation between the width to length ratio and bimalleolar angle in the talipes equinovarus cases with the Pearson correlation coefficient. RESULTS Statistically significant differences were shown between the two groups (P< .001) for the three foot measurements, and a significant negative correlation was found between the width to length ratio and bimalleolar angle of the affected foot (r = -0.857). CONCLUSIONS The fetal plantar shape can provide valuable information for prenatal diagnosis of clubfoot. Compared with a normal foot, a clubfoot tends to be wider and shorter. A higher width to length ratio is associated with a smaller bimalleolar angle and indicates a more severe talipes equinovarus deformity.
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Affiliation(s)
- Huifang Liao
- Department of Ultrasound, Shengjing Hospital of China Medical University, 36 Sanhao St 110004, Shenyang, Liaoning, China
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Nemec U, Nemec SF, Kasprian G, Brugger PC, Bettelheim D, Wadhawan I, Kolb A, Graham JM, Rimoin DL, Prayer D. Clubfeet and associated abnormalities on fetal magnetic resonance imaging. Prenat Diagn 2012; 32:822-8. [PMID: 22678996 DOI: 10.1002/pd.3911] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Clubfoot, or talipes equinovarus (TEV), is commonly diagnosed on prenatal ultrasound. This study sought to visualize TEV and associated abnormalities on fetal magnetic resonance imaging (MRI) compared with ultrasound. METHODS This retrospective study included the MRI scans of 44 fetuses with TEV using postnatal assessment and autopsy as standard of reference. Isolated TEV was differentiated from complex TEV with associated abnormalities. MRI findings and previous ultrasound diagnoses were compared. RESULTS Isolated TEV was found in 19/44 (43.2%) fetuses and complex TEV in 25/44 (56.8%). Associated abnormalities consisted of the following: central nervous system/spinal abnormalities in 13/25 (52.0%) fetuses; musculoskeletal abnormalities in 7/25 (28.0%); thoracic abnormalities in 3/25 (12.0%); a tumor in one case; and hydrops fetalis in one. Of the 44 cases, 35 (79.5%) pregnancies were delivered, and nine (20.5%) pregnancies, which were terminated, all had complex TEV. Of the 42 available ultrasound reports, additional MRI findings were made in 8/42 (19.0%) cases. MRI did not add findings in isolated TEV on ultrasound. In 4/44 (9.1%) cases, autopsy revealed additional findings compared with prenatal imaging. CONCLUSION Fetal MRI enables differentiation between isolated and complex TEV. Isolated TEV on ultrasound may not be an MRI indication, whereas MRI may be useful in cases of complex TEV.
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Affiliation(s)
- Ursula Nemec
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University Vienna, Vienna, Austria.
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Agarwal A, Qureshi NA, Kumar P, Garg A, Gupta N. Ultrasonographic evaluation of Achilles tendons in clubfeet before and after percutaneous tenotomy. J Orthop Surg (Hong Kong) 2012; 20:71-4. [PMID: 22535815 DOI: 10.1177/230949901202000114] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To measure the size of the Achilles tendons in congenital clubfeet using ultrasonography before and after percutaneous tenotomy. METHODS 15 boys and 12 girls (39 feet) aged one to 11 (mean, 5) months with idiopathic clubfeet underwent percutaneous tenotomy (Ponseti method). The size of each Achilles tendon was measured ultrasonographically by a single radiologist before and after surgery. In patients with unilateral clubfoot, the normal foot was used as a referent. Longitudinal scans assessed the echotexture, echogenicity, and continuity of the tendon. Transverse scans assessed the shape, echotexture, echogenicity, thickness, and width of the tendon. The size of the Achilles tendon was estimated as an elliptical area using the formula: pi(thickness)x(width)/4. RESULTS Before tenotomy, homogenous, hyperechoic, and linear continuous shadows were noted in longitudinal scans of both the normal and affected Achilles tendons. In transverse scans, the tendons were elliptical, homogenous, and echogenic in appearance. Four weeks after tenotomy, the tendons appeared as heterogeneous, linear continuous shadows with regular margins irrespective of patient age. There was decreased echogenicity in the treated foot. The transverse section of the tendons was elliptical with a heterogeneous echotexture that was predominantly hypoechoic. There was no significant difference in normal, unilateral, and bilateral tendons before and after tenotomy. CONCLUSION The study reasserts functional continuity of the Achilles tendons 4 weeks after tenotomy using clinical and ultrasonographic methods.
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Affiliation(s)
- Anil Agarwal
- Department of Orthopaedics, CNBC, Geeta Colony, Delhi, India.
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Radler C, Myers AK, Burghardt RD, Arrabal PP, Herzenberg JE, Grill F. Maternal attitudes towards prenatal diagnosis of idiopathic clubfoot. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:658-662. [PMID: 21229570 DOI: 10.1002/uog.8932] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/24/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To examine maternal attitudes towards prenatal diagnosis of idiopathic clubfoot and to determine the incidence of false-negative ultrasound examinations. METHODS Surveys were mailed to mothers of patients with clubfoot born between 2000 and 2007 who were treated at either Sinai Hospital of Baltimore or Orthopaedic Hospital Speising. Exclusion criteria were underlying syndrome, genetic abnormality and multiple pregnancy. The survey asked the mother whether she had had any ultrasound examinations before her child was born, whether any of these had shown clubfoot, and whether she would have preferred to find out about her child's clubfoot before birth or after birth. RESULTS Mothers completed 220 (USA, 105 surveys; Austria, 115 surveys) of 401 mailed surveys. The prenatal detection rate was 60% in the USA compared with 25% in Austria (P = 0.001). Overall, 74% of mothers indicated a preference for prenatal diagnosis and 24% indicated a preference for postnatal diagnosis of the condition. Of 92 patients diagnosed prenatally, 96% of mothers indicated a preference for a prenatal diagnosis. Of 128 patients diagnosed postnatally, 58% of mothers indicated a preference for prenatal diagnosis, 38% for postnatal diagnosis and 4% were undecided. CONCLUSIONS The diagnosis of clubfoot is still often missed during routine ultrasound examination. When a prenatal diagnosis is made, most mothers appreciate having this information. However, when prenatal diagnosis is missed, a significant proportion of mothers seem to accept the false-negative diagnosis retrospectively.
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Affiliation(s)
- C Radler
- Orthopaedic Hospital Speising, Vienna, Austria
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29
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Abstract
Congenital clubfoot is a relatively common lower limb deformity that is increasingly managed by non-operative methods of serial manipulation and immobilization. This review looks at aetiology, examination techniques and severity scoring, and provides an overview of operative and non-operative methods of treatment.
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Affiliation(s)
- Henry B Colaço
- Department of Trauma and Orthopaedics at Eastbourne District General Hospital, Eastbourne, East Sussex BN21 2UN
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30
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Abstract
BACKGROUND Improvements in obstetric sonography (US) have led to an increased prenatal detection of clubfoot, but studies have not been able to correlate sonographic severity to clinical deformity at birth. The purpose of this study was to decrease the false positive (FP) rate for prenatally identified clubfeet, and to predict clinical severity using a new prenatal sonographic classification system. METHODS We retrospectively identified all pregnant patients referred to the fetal care center at our institution for a diagnosis of clubfoot between 2002 and 2007. A total of 113 fetuses were identified. Follow-up information was available for 107 fetuses (95%). Out of 107 fetuses, 17 were terminated or died shortly after birth. Seven patients had normal studies or were not seen at our center. Out of 83 patients, 42 had an US available for rereview. A novel sonographic severity scale for clubfoot (mild/moderate/severe) was assigned by a radiologist specializing in prenatal US to each fetus based on specific anatomic features. The prenatal sonographic scores were then assessed with respect to final postnatal clinical diagnosis and to clinical severity. RESULTS None of the pregnancies were terminated because of an isolated diagnosis of clubfoot. Of the remaining 83 fetuses with a prenatal diagnosis of at least 1 clubfoot, 67 had a clubfoot documented at birth (FP=19%). A foot classified as "mild" on prenatal US was significantly less likely to be a true clubfoot at birth than when a "moderate" or "severe" diagnosis was given (Odds Ratio=21, P<0.0001). If "mild" clubfoot patients were removed from the analysis, our FP rate decreased to 3/42. For a subgroup in which postnatal DiMeglio scoring was available, prenatal sonographic stratification of clubfoot did not relate to postnatal clinical severity. CONCLUSIONS Our initial experience with this novel sonographic scoring system showed improved detection of a true clubfoot prenatally and a decrease in the FP rate. An isolated "mild" clubfoot diagnosed on a prenatal sonogram is less likely to be a clubfoot at birth; this will have substantial impact on prenatal counseling. LEVEL OF EVIDENCE Level III Diagnostic Study.
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Athanatos D, Tsakalidis C, Tampakoudis GP, Papastergiou MN, Tzevelekis F, Pados G, Assimakopoulos EA. Embryo with XYY syndrome presenting with clubfoot: a case report. CASES JOURNAL 2009; 2:8404. [PMID: 19918427 PMCID: PMC2769437 DOI: 10.4076/1757-1626-2-8404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 08/19/2009] [Indexed: 11/09/2022]
Abstract
Talipes equinovarus (clubfoot) is a skeletal anomaly of the embryo's legs, with a frequency of 1-3:1000 living born babies. It may occur as an independent anomaly, or as part of a syndrome with concomitant chromosomal abnormalities.XYY syndrome is a quite rare sex chromosomal abnormality with 47, XYY karyotype. Prenatal diagnosis is usually accidental because the syndrome is not associated with increased prevalence of sonographically detectable defects. The possibility of co-existence of skeletal anomalies in embryos with 47, XYY karyotype is scant, with only a few cases reported in the literature.An amniocentesis was performed in an embryo at the 21(st) week of gestation because clubfoot was detected in the 2(nd) trimester scan, and the embryo was found to have abnormal karyotype of 47, XYY. Current opinions and management dilemmas are discussed.
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Affiliation(s)
- Dimitrios Athanatos
- First Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, ‘Papageorgiou’ HospitalThessalonikiGreece
| | - Christos Tsakalidis
- Second Department of Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, ‘Papageorgiou’ HospitalThessalonikiGreece
| | - George P Tampakoudis
- First Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, ‘Papageorgiou’ HospitalThessalonikiGreece
| | - Maria N Papastergiou
- First Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, ‘Papageorgiou’ HospitalThessalonikiGreece
| | - Fillipos Tzevelekis
- First Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, ‘Papageorgiou’ HospitalThessalonikiGreece
| | - George Pados
- First Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, ‘Papageorgiou’ HospitalThessalonikiGreece
| | - Efstratios A Assimakopoulos
- First Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, ‘Papageorgiou’ HospitalThessalonikiGreece
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Abstract
AIM Talipes is a congenital anomaly that can be corrected conservatively or surgically. Despite advances in management, a proportion of pregnancies still result in termination. We therefore aimed to establish the birth prevalence, interventions and outcome of talipes in our population. METHODS Cases with foetal talipes were identified from the ultrasound register at the James Cook University Hospital between 1990 and 2006. Infants with congenital talipes between 1998 and 2006 were identified from the physiotherapy database. Management details were obtained from case records. RESULTS A total of 46 cases with foetal talipes were identified among 75 933 pregnancies. Of the 34 live-born infants, 24 (70.5%) required surgery to correct the talipes. Congenital talipes was found in 69 infants, giving a birth prevalence of 2 per 1000 live births. Sixteen (72.7%) infants with an antenatal diagnosis required surgical correction. Infants with an antenatal diagnosis were at an increased risk of requiring surgery (relative risk [RR]= 1.6). CONCLUSION Surgical management was required in more than two-thirds of babies with foetal talipes. Conservative management was successful in the majority of the babies without an antenatal diagnosis. Infants with an antenatal diagnosis are 1.6 times as likely to need surgical correction as infants without an antenatal diagnosis.
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Affiliation(s)
- Ravi Swamy
- Department of Neonatology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Canto MJ, Cano S, Palau J, Ojeda F. Prenatal diagnosis of clubfoot in low-risk population: associated anomalies and long-term outcome. Prenat Diagn 2008; 28:343-6. [PMID: 18382991 DOI: 10.1002/pd.1984] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To evaluate associated congenital anomaly risk, need for surgical treatment and long-term outcome in prenatally diagnosed clubfoot. METHODS A retrospective study of 20 663 pregnant women who underwent routine ultrasound scanning at 18 to 22 weeks of gestation. Clubfoot was considered as complex or isolated if other structural or chromosomal abnormalities were also present or not. RESULTS Forty-two cases of congenital clubfoot were diagnosed (incidence: 0.2%), 28 of them (66.6%) were isolated and 14 (33.3%) were complex, of which 3 (7.1%) had an abnormal karyotype and 11 (26.2%) had an associated structural anomaly. The false-positive rate was 2.3% (1 out of 32 liveborns). Out of the 41 confirmed affected fetuses, the defect was unilateral in 12 (29.3%) and bilateral in 29 (70.7%) cases. Surgery was necessary in 12 of the newborns (38.7%). The presence of a bilateral clubfoot was unrelated to either the presence of associated anomalies (p = 0.40) or to the necessity of surgery (p = 0.48). CONCLUSIONS We provide outcome data about fetuses prenatally diagnosed for clubfoot. One-third are complex cases associated with other congenital anomalies. For isolated clubfoot, the risk of requiring surgery is about 40%. The detection of a bilateral defect does not worsen the prognosis.
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Affiliation(s)
- M J Canto
- Hospital General de Granollers, Barcelona, Spain.
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Abstract
Talipes equinovarus is one of the more common congenital abnormalities affecting the lower limb and can be challenging to manage. This review provides a comprehensive update on idiopathic congenital talipes equinovarus with emphasis on the initial treatment. Current management is moving away from operative towards a more conservative treatment using the Ponseti regime. The long-term results of surgical correction and the recent results of conservative treatment will be discussed.
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Affiliation(s)
- A Siapkara
- The Royal Hospital for Sick Children, Yorkhill, Glasgow, UK
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Cohen-Overbeek TE, Grijseels EWM, Lammerink EAG, Hop WCJ, Wladimiroff JW, Diepstraten AFM. Congenital talipes equinovarus: comparison of outcome between a prenatal diagnosis and a diagnosis after delivery. Prenat Diagn 2006; 26:1248-53. [PMID: 17099928 DOI: 10.1002/pd.1596] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To establish the impact on outcome of prenatally versus postnatally detected talipes equinovarus (TEV). METHODS The prenatal group was represented by pregnancies with sonographically detected TEV of which 18 were isolated and 39 were complex. The postnatal group contained 64 infants with an isolated and 10 infants with a complex TEV detected at birth. Treatment consisted of redressement followed by surgical postero-lateral or postero-medial release at the University Paediatric Orthopaedic Centre. The postnatal isolated TEV group underwent redressement treatment at the University Centre (subset A, n = 39) or at a regional general hospital (subset B, n = 25). RESULTS For isolated TEV, statistically significant difference existed for the surgical procedure (p < 0.001), age at surgery (p < 0.01) and admission time (p < 0.001) between the prenatal and postnatal subset B and between the postnatal subsets A and B. For the complex TEV, no significant difference was found for these variables between the six surviving infants of the prenatal group and the postnatal group. CONCLUSION Prenatal detection of isolated TEV results in earlier and less complicated postnatal surgery and a shorter admission time, provided treatment is arranged at a paediatric orthopaedic centre. After prenatal detection of a complex TEV, survival is low and determined by associated anomalies.
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Affiliation(s)
- T E Cohen-Overbeek
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands.
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