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Milanovic F, Ducic S, Jankovic M, Sindjic-Antunovic S, Dubljanin-Raspopović E, Aleksic M, Djuricic G, Nikolic D. Clinical Characteristics and Whole Exome Sequencing Analysis in Serbian Cases of Clubfoot Deformity-Single Center Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:647. [PMID: 38929227 PMCID: PMC11201961 DOI: 10.3390/children11060647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/09/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Recognized as one of the most serious musculoskeletal deformities, occurring in 1-2 per 1000 newborns, 80% of clubfeet are idiopathic while 20% present with associated malformations. The etiopathogenesis of clubfoot is described as multifactorial, including both genetic and environmental risk factors. The aim of this study was to analyze possible genetic causes of isolated and syndromic clubfoot in Serbian children, as well as to correlate clinical and genetic characteristics that would provide insight into clubfoot etiopathogenesis and possibly contribute to global knowledge about clinical features of different genetically defined disorders. METHODS We evaluated 50 randomly selected, eligible children with clubfoot aged 3 to 16 years that were initially hospitalized and treated at University Children's Hospital between November 2006 and November 2022. The tested parameters were gender, age, dominant foot, affected foot, degree of deformity, treatment, neuromuscular disorders, positive family history, and maternal smoking. According to the presence of defined genetic mutation/s by whole exome sequencing (WES), patients were separated into two groups: positive (with genetic mutation/s) and negative (without genetic mutation/s). RESULTS Seven patients were found to be positive, i.e., with genetic mutation/s. A statistically significant difference between categorical variables was found for families with a history of clubfoot, where more than half (57.14%) of patients with confirmed genetic mutation/s also had a family history of genetic mutation/s (p = 0.023). CONCLUSIONS The results from this study further expand the genetic epidemiology of clubfoot. This study contributes to the establishment of genetic diagnostic strategies in pediatric patients with this condition, which can lead to more efficient genetic diagnosis.
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Affiliation(s)
- Filip Milanovic
- Pediatric Surgery Department, University Children’s Hospital, 11000 Belgrade, Serbia; (S.D.); (S.S.-A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (E.D.-R.); (M.A.); (G.D.); (D.N.)
| | - Sinisa Ducic
- Pediatric Surgery Department, University Children’s Hospital, 11000 Belgrade, Serbia; (S.D.); (S.S.-A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (E.D.-R.); (M.A.); (G.D.); (D.N.)
| | - Milena Jankovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (E.D.-R.); (M.A.); (G.D.); (D.N.)
- Neurology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Sanja Sindjic-Antunovic
- Pediatric Surgery Department, University Children’s Hospital, 11000 Belgrade, Serbia; (S.D.); (S.S.-A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (E.D.-R.); (M.A.); (G.D.); (D.N.)
| | - Emilija Dubljanin-Raspopović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (E.D.-R.); (M.A.); (G.D.); (D.N.)
- Center for Physical Medicine and Rehabilitation, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milica Aleksic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (E.D.-R.); (M.A.); (G.D.); (D.N.)
- Center for Physical Medicine and Rehabilitation, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Goran Djuricic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (E.D.-R.); (M.A.); (G.D.); (D.N.)
- Radiology Department, University Children’s Hospital, 11000 Belgrade, Serbia
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (E.D.-R.); (M.A.); (G.D.); (D.N.)
- Department of Physical Medicine and Rehabilitation, University Children’s Hospital, 11000 Belgrade, Serbia
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Dimeglio's derotation of calcaneo pedal block and Pirani's talar head reduction: a quantitative matching. J Pediatr Orthop B 2021; 30:467-470. [PMID: 32991373 DOI: 10.1097/bpb.0000000000000812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We aimed to determine the quantitative value of derotation of calcaneo pedal block (DCPB) of Dimeglio system equivalent to talar head reduction of Pirani system. We also compared the ankle dorsiflexion obtained post tenotomy for different measures of DCPB. The study involved 53 idiopathic clubfoot children (86 feet) treated with Ponseti technique. Percutaneous Achilles tenotomy to correct ankle equinus was performed when forefoot adduction, heel varus were corrected and ankle dorsiflexion was <10°. Pirani's coverage of lateral head of talus was taken as a determinant of adequate DCPB and to perform tenotomy. Mean patient age at enrollment was 60.9 ± 71.1 days. The median pre and posttreatment Dimeglio scores were 13 (range 4-20) and 0 (range 0-3), respectively. DCPB at the time of talar head reduction was 53.8 ± 9.8°. In 85% feet, talar head reduction was obtained by DCPB 60° and all were reduced by 70°. The average ankle dorsiflexion improved significantly with DCPB ≥ 50°. The measure at which DCPB matched with talar head reduction of Pirani system was variable (40-70°). In all feet, talar head was reduced by 70° DCPB. Post tenotomy, ankle dorsiflexion was better with DCPB ≥ 50°.
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Alberghina F, Testa G, Monforte S, Pavone V, Andreacchio A. From Codivilla to Ponseti: historical narrative review on clubfoot treatment in Italy. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1108. [PMID: 34423020 PMCID: PMC8339829 DOI: 10.21037/atm-20-7956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/31/2021] [Indexed: 11/06/2022]
Abstract
Objective This narrative review aims to summarize the historical steps of clubfoot treatment in Italy, identifying the centuries-old historical advancement in the deformity management and the most influent involved people. Background Clubfoot, also referred to as congenital talipes equinovarus, is a relatively common deformity that has significative consequences in the child if it is left untreated. Effective and early treatment of clubfoot has been praised as one of the most successful practice of modern pediatric orthopedics and both surgical and conservative techniques have been proposed over the decades. As an example, Codivilla’s posteromedial release (PMR) has been known internationally as one of the milestones of surgical treatment. Methods The narrative review includes clinical studies and reviews concerning clubfoot that were written in English, German and Italian. As an historical review, no limits of years were considered. The search was performed using PubMed, Google Scholar, Scopus, Medline and Cochrane Library databases up to January 2021. A combination of search terms including ‘history’, ‘clubfoot’, ‘conservative management’, ‘Codivilla’, ‘Ponseti method’, ‘relapse’ was utilized. Particular attention was given to papers written by Italian authors. Conclusions Current clubfoot treatment arises from several studies and clinical research over the centuries. Many surgeons, starting from mid-16th century, have studied the deformity trying to find a successful and effective technique to achieve full correction. Italian scientists, surgeons and prestigious institutions surely took part in this process.
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Affiliation(s)
- Flavia Alberghina
- Department of Orthopedics and Traumatology, "CTO" Hospital, University of Turin, Torino, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico "Rodolico - San Marco", University of Catania, Catania, Italy
| | - Sergio Monforte
- Pediatric Orthopedic Surgery Department, "Buzzi" Children's Hospital, Milano, Italy
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico "Rodolico - San Marco", University of Catania, Catania, Italy
| | - Antonio Andreacchio
- Pediatric Orthopedic Surgery Department, "Buzzi" Children's Hospital, Milano, Italy
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Khan S, Khan MA, Chinoy MA, Ahmed S. Flat Top Talus: Complication of Ponseti Method or Overcorrection? Cureus 2021; 13:e13390. [PMID: 33754113 PMCID: PMC7976371 DOI: 10.7759/cureus.13390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose Deformation of talus in idiopathic clubfoot is a common problem both surgically and after treatment with the Ponseti technique, although the cause of deformation and its clinical impact on the function of the ankle is not yet known. The goal of this research was to evaluate factors leading to talar dome deformation (flat-top talus) after the Ponseti technique Methods This was a single-center, cross-sectional study. Fifty patients with virgin idiopathic clubfoot were enrolled from our consecutive series of data from August 2017 to January 2018 from our clubfoot patients who completed their casting and bracing protocol. Weight-bearing lateral X-rays of the ankle were examined in patients to determine the flattening of the talus dome and its correlation with age, sex, BMI, number of casts, and casting period. In these patients, the frequency of tenotomy and its relationship to the flat top talus was also examined. Results The study included a total of 50 children, of which 36 (72%) were boys and 14 (28%) were girls. The mean age, height, weight, and BMI of the children were 5.06 ± 0.79 years, 101.6 ± 6.34 cm, and 19.7 ± 1.57 kg, respectively. No significant difference between the normal and flat top talus category was found in age and BMI (p=0.611 and 0.997, respectively). Whereas, relative to normal children, the children who had flat-top talus were on casts for a longer period of time (median: 9 vs. 6 weeks, p=0.026). In addition, a higher proportion of children with more than six casts developed flat-top talus than those with fewer than six casts (69.2% vs. 30.8%, p=0.005). After treatment, a total of 13 (26%) patients developed flat top talus, of which 11 (84.6%) were boys and two (15.4%) were girls (p=0.303). No substantial association between tenotomy and flat top talus (p=0.340) could be identified. Conclusion Flat top talus is a complication of improper manipulation specifically correlated with the number of Ponseti casts applied. Maintenance of cast treatment for more than three months may result in flat-top talus with no significant association with tenotomy of the tendoachilles.
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Affiliation(s)
- Shahbaz Khan
- Orthopaedics and Traumatology, Ziauddin University Hospital Karachi, Karachi, PAK
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Bettuzzi C, Abati CN, Salvatori G, Zanardi A, Lampasi M. Interobserver reliability of Diméglio and Pirani score and their subcomponents in the evaluation of idiopathic clubfoot in a clinical setting: a need for improved scoring systems. J Child Orthop 2019; 13:478-485. [PMID: 31695815 PMCID: PMC6808069 DOI: 10.1302/1863-2548.13.190010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Diméglio (DimS) and Pirani (PirS) scores are the most commonly used scoring systems for evaluation of clubfoot, with many centres performing both. Interobserver reliability of their global score has been rated high in a few studies, but agreement of their subcomponents has been poorly investigated. The aim of the study was to assess interrater reliability of global scores and of items in a clinical setting and to analyse overlapping features of the two scores. METHODS Fifty-six consecutive idiopathic clubfeet undergoing correction using the Ponseti method were independently evaluated at each casting session by two trained paediatric orthopaedic surgeons using both scores. Interobserver reliability of collected data was analysed; a kappa coefficient > 0.60 was considered adequate. RESULTS For DimS and PirS, the Pearson correlation coefficients were 0.87 and 0.91 (p < .0001) respectively, and kappa coefficients were 0.23 and 0.31. Among subcomponents, kappa values were rated > 0.60 only for equinus and curvature of lateral border in PirS; muscular abnormality in DimS was rated 0.74 but a high prevalence index (0.94) indicated influence of scarce prevalence of this feature. All other items showed k < 0.60 and were considered to be improved.For overlapping features: posterior and medial crease showed similar agreement in the two systems, items describing equinus and midfoot adduction were much more reliable in PirS than in DimS. CONCLUSIONS In a clinical setting, despite a high correlation of evaluations for total scores, the interobserver agreement of DimS and PirS was not adequate and only a few items were substantially reliable. Simultaneous use of two scores seemed redundant and some overlapping features showed different reliability according to criterion or scale used. Future scoring systems should improve these limitations. LEVEL OF EVIDENCE Level I - Diagnostic studies.
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Affiliation(s)
- C. Bettuzzi
- Department of Paediatric Orthopaedics, Anna Meyer Children’s Hospital, Florence, Italy,Correspondence should be sent to C. Bettuzzi, Anna Meyer Children’s Hospital, Department of Paediatric Orthopaedics, Viale Pieraccini 24, 50139, Florence, Italy. E-mail:
| | - C. N. Abati
- Department of Paediatric Orthopaedics, Anna Meyer Children’s Hospital, Florence, Italy
| | - G. Salvatori
- Department of Paediatric Orthopaedics, Anna Meyer Children’s Hospital, Florence, Italy
| | - A. Zanardi
- Department of Paediatric Orthopaedics, Anna Meyer Children’s Hospital, Florence, Italy
| | - M. Lampasi
- Department of Paediatric Orthopaedics, Anna Meyer Children’s Hospital, Florence, Italy
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Lampasi M, Abati CN, Bettuzzi C, Stilli S, Trisolino G. Comparison of Dimeglio and Pirani score in predicting number of casts and need for tenotomy in clubfoot correction using the Ponseti method. INTERNATIONAL ORTHOPAEDICS 2018; 42:2429-2436. [PMID: 29594373 DOI: 10.1007/s00264-018-3873-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 02/28/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE The Dimeglio and the Pirani scores are largely used to rate clubfoot at presentation and monitor correction. To date, the accuracy of these scores in predicting appropriate treatment is controversial. The aim of this study was to investigate the accuracy of Dimeglio and Pirani scores in predicting the number of casts and the need for tenotomy in clubfoot correction using the Ponseti method. METHODS Ninety-one consecutive feet (54 patients; mean age at presentation: 28 ± 15 days) undergoing clubfoot correction using the Ponseti method were prospectively followed from first casting to correction. All feet were scored according to the Dimeglio and Pirani score. The relationships between the two scores, the number of casts and the need for tenotomy were analysed. RESULTS Initial correction was achieved in all feet. Both Dimeglio (r = .73; p value < .0005) and Pirani scores (r = .56; p value < .000) showed good association with the number of casts. Multiple linear regression showed a high collinearity of the two scores but a more significant contribution of the Dimeglio score. Among subcomponents, hindfoot score, midfoot score, varus and muscular abnormality were independent predictors of the number of casts. Both Dimeglio and Pirani scores were significantly associated with the need for tenotomy (p value = .0000), and odds ratios and cut-off points were calculated. The receiving operator curve (ROC) analysis showed slightly better performance of the Dimeglio in comparison with the Pirani score in predicting the need for tenotomy, but the difference between the two areas under the curve (AUC) was not significant (p = .48). CONCLUSIONS A quite accurate prediction of the number of casts and the need for tenotomy can be performed in most cases. The Dimeglio score showed slightly better accuracy in predicting both steps of Ponseti treatment.
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Affiliation(s)
- Manuele Lampasi
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children's Hospital, Viale Pieraccini 24, 50139, Florence, Italy.
| | - Caterina Novella Abati
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children's Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Camilla Bettuzzi
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children's Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Stefano Stilli
- Department of Paediatric Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, Italy
| | - Giovanni Trisolino
- Department of Paediatric Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, Italy
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Lampasi M, Abati CN, Stilli S, Trisolino G. Use of the Pirani score in monitoring progression of correction and in guiding indications for tenotomy in the Ponseti method: Are we coming to the same decisions? J Orthop Surg (Hong Kong) 2018. [PMID: 28625097 DOI: 10.1177/2309499017713916] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The Pirani score is widely used in the treatment of idiopathic clubfoot. Some authors recommended to base decision for Achilles tenotomy in Ponseti method on this score (hindfoot score [HFS] > 1, once reducibility of lateral head of talus (LHT) is zero) instead of originally described indications (dorsiflexion < -10-15° once complete abduction is achieved). Yet correspondence of these indications has not been evaluated. Aim of this study was to verify whether in a cohort, where decision is based on dorsiflexion, the Pirani score corresponds to the limits suggested. Secondarily, to describe temporal variation in Pirani score along treatment, which has not been previously investigated. METHODS In a prospective study, 79 idiopathic clubfeet in 47 cases consecutively treated with Ponseti method by a single orthopaedic surgeon were evaluated at each casting session with Pirani system; score progression and scores at time of decision to perform tenotomy were determined. RESULTS HFS and its subcomponents showed minimal improvement during subsequent sessions of casting and then rapid correction with tenotomy. Medial crease resolved rapidly. Midfoot score and its remaining subcomponents corrected gradually. Total Pirani score showed initially a progressive correction and then a more abrupt improvement with tenotomy. At the time of decision to perform tenotomy, in 8 (10.1%) of 79 cases, the decision whether or not to perform tenotomy based on dorsiflexion would have been different based on the cut-offs for Pirani score suggested. CONCLUSION Using Pirani score in guiding indication for tenotomy may imply different decisions in a portion of cases, which should be considered when comparing series.
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Affiliation(s)
- Manuele Lampasi
- 1 Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children's Hospital, Viale Pieraccini 24, Florence, Italy
| | - C N Abati
- 1 Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children's Hospital, Viale Pieraccini 24, Florence, Italy
| | - S Stilli
- 2 Department of Paediatric Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, via Pupilli 1, Bologna, Italy
| | - G Trisolino
- 2 Department of Paediatric Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, via Pupilli 1, Bologna, Italy
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Kolb A, Willegger M, Schuh R, Kaider A, Chiari C, Windhager R. The impact of different types of talus deformation after treatment of clubfeet. INTERNATIONAL ORTHOPAEDICS 2016; 41:93-99. [DOI: 10.1007/s00264-016-3301-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/22/2016] [Indexed: 11/30/2022]
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