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do Amaral E Castro A, Peixoto JB, Miyahara LK, Akuri MC, Moriwaki TL, Sato VN, Rissato UP, Pinto JA, Taneja AK, Aihara AY. Clubfoot: Congenital Talipes Equinovarus. Radiographics 2024; 44:e230178. [PMID: 38935547 DOI: 10.1148/rg.230178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Congenital talipes equinovarus (CTEV), also known as clubfoot, is a common musculoskeletal entity that affects one to two per 1000 live births worldwide. Imaging modalities including radiography, US, and MRI have emerged as valuable tools for the diagnosis, treatment, and monitoring of CTEV. The deformity is characterized by midfoot cavus, forefoot adductus, and hindfoot varus and equinus. The Ponseti method of manipulation and serial casting is the standard treatment of CTEV. Radiography shows the anatomy, position, and relationships of the different bones of the foot. US allows accurate assessment of cartilaginous and bony structures, in addition to its inherent advantages such as absence of ionizing radiation exposure. One of the indications for US is to monitor the response to Ponseti method treatment. MRI enables visualization of bones, cartilage, and soft tissues and allows multiplanar evaluation of deformities, providing a comprehensive imaging analysis of CTEV. An integrated approach that combines clinical examination and imaging findings is essential for effective management of CTEV. The authors provide a comprehensive overview of CTEV with a review of imaging modalities to help evaluate CTEV, focusing on radiography, US, and MRI. Using this article as a guide, radiologists involved in the assessment and treatment of CTEV can contribute to the management of the condition. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Adham do Amaral E Castro
- From the Division of Musculoskeletal Radiology, Department of Diagnostic Imaging (A.d.A.e.C., J.B.P., L.K.M., M.C.A., T.L.M., V.N.S., A.Y.A.), and Discipline of Pediatric Orthopedics, Department of Orthopedics and Traumatology (U.P.R., J.A.P.), Napoleão de Barros St, 800-Vila Clementino, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, SP, Brazil 04024-002; Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); Department of Diagnostic Imaging, DASA/Laboratório Delboni Auriemo, São Paulo, SP, Brazil (T.L.M., V.N.S., A.Y.A.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil (V.N.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX (A.K.T.)
| | - Júlia B Peixoto
- From the Division of Musculoskeletal Radiology, Department of Diagnostic Imaging (A.d.A.e.C., J.B.P., L.K.M., M.C.A., T.L.M., V.N.S., A.Y.A.), and Discipline of Pediatric Orthopedics, Department of Orthopedics and Traumatology (U.P.R., J.A.P.), Napoleão de Barros St, 800-Vila Clementino, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, SP, Brazil 04024-002; Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); Department of Diagnostic Imaging, DASA/Laboratório Delboni Auriemo, São Paulo, SP, Brazil (T.L.M., V.N.S., A.Y.A.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil (V.N.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX (A.K.T.)
| | - Lucas K Miyahara
- From the Division of Musculoskeletal Radiology, Department of Diagnostic Imaging (A.d.A.e.C., J.B.P., L.K.M., M.C.A., T.L.M., V.N.S., A.Y.A.), and Discipline of Pediatric Orthopedics, Department of Orthopedics and Traumatology (U.P.R., J.A.P.), Napoleão de Barros St, 800-Vila Clementino, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, SP, Brazil 04024-002; Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); Department of Diagnostic Imaging, DASA/Laboratório Delboni Auriemo, São Paulo, SP, Brazil (T.L.M., V.N.S., A.Y.A.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil (V.N.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX (A.K.T.)
| | - Marina C Akuri
- From the Division of Musculoskeletal Radiology, Department of Diagnostic Imaging (A.d.A.e.C., J.B.P., L.K.M., M.C.A., T.L.M., V.N.S., A.Y.A.), and Discipline of Pediatric Orthopedics, Department of Orthopedics and Traumatology (U.P.R., J.A.P.), Napoleão de Barros St, 800-Vila Clementino, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, SP, Brazil 04024-002; Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); Department of Diagnostic Imaging, DASA/Laboratório Delboni Auriemo, São Paulo, SP, Brazil (T.L.M., V.N.S., A.Y.A.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil (V.N.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX (A.K.T.)
| | - Tatiane L Moriwaki
- From the Division of Musculoskeletal Radiology, Department of Diagnostic Imaging (A.d.A.e.C., J.B.P., L.K.M., M.C.A., T.L.M., V.N.S., A.Y.A.), and Discipline of Pediatric Orthopedics, Department of Orthopedics and Traumatology (U.P.R., J.A.P.), Napoleão de Barros St, 800-Vila Clementino, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, SP, Brazil 04024-002; Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); Department of Diagnostic Imaging, DASA/Laboratório Delboni Auriemo, São Paulo, SP, Brazil (T.L.M., V.N.S., A.Y.A.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil (V.N.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX (A.K.T.)
| | - Vitor N Sato
- From the Division of Musculoskeletal Radiology, Department of Diagnostic Imaging (A.d.A.e.C., J.B.P., L.K.M., M.C.A., T.L.M., V.N.S., A.Y.A.), and Discipline of Pediatric Orthopedics, Department of Orthopedics and Traumatology (U.P.R., J.A.P.), Napoleão de Barros St, 800-Vila Clementino, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, SP, Brazil 04024-002; Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); Department of Diagnostic Imaging, DASA/Laboratório Delboni Auriemo, São Paulo, SP, Brazil (T.L.M., V.N.S., A.Y.A.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil (V.N.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX (A.K.T.)
| | - Ulysses P Rissato
- From the Division of Musculoskeletal Radiology, Department of Diagnostic Imaging (A.d.A.e.C., J.B.P., L.K.M., M.C.A., T.L.M., V.N.S., A.Y.A.), and Discipline of Pediatric Orthopedics, Department of Orthopedics and Traumatology (U.P.R., J.A.P.), Napoleão de Barros St, 800-Vila Clementino, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, SP, Brazil 04024-002; Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); Department of Diagnostic Imaging, DASA/Laboratório Delboni Auriemo, São Paulo, SP, Brazil (T.L.M., V.N.S., A.Y.A.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil (V.N.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX (A.K.T.)
| | - José A Pinto
- From the Division of Musculoskeletal Radiology, Department of Diagnostic Imaging (A.d.A.e.C., J.B.P., L.K.M., M.C.A., T.L.M., V.N.S., A.Y.A.), and Discipline of Pediatric Orthopedics, Department of Orthopedics and Traumatology (U.P.R., J.A.P.), Napoleão de Barros St, 800-Vila Clementino, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, SP, Brazil 04024-002; Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); Department of Diagnostic Imaging, DASA/Laboratório Delboni Auriemo, São Paulo, SP, Brazil (T.L.M., V.N.S., A.Y.A.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil (V.N.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX (A.K.T.)
| | - Atul K Taneja
- From the Division of Musculoskeletal Radiology, Department of Diagnostic Imaging (A.d.A.e.C., J.B.P., L.K.M., M.C.A., T.L.M., V.N.S., A.Y.A.), and Discipline of Pediatric Orthopedics, Department of Orthopedics and Traumatology (U.P.R., J.A.P.), Napoleão de Barros St, 800-Vila Clementino, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, SP, Brazil 04024-002; Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); Department of Diagnostic Imaging, DASA/Laboratório Delboni Auriemo, São Paulo, SP, Brazil (T.L.M., V.N.S., A.Y.A.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil (V.N.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX (A.K.T.)
| | - André Y Aihara
- From the Division of Musculoskeletal Radiology, Department of Diagnostic Imaging (A.d.A.e.C., J.B.P., L.K.M., M.C.A., T.L.M., V.N.S., A.Y.A.), and Discipline of Pediatric Orthopedics, Department of Orthopedics and Traumatology (U.P.R., J.A.P.), Napoleão de Barros St, 800-Vila Clementino, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, SP, Brazil 04024-002; Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); Department of Diagnostic Imaging, DASA/Laboratório Delboni Auriemo, São Paulo, SP, Brazil (T.L.M., V.N.S., A.Y.A.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil (V.N.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX (A.K.T.)
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Liu W, Zhang S, Zhang W, Li F, Tueraili A, Qi L, Wang C. Clinical application of 3D printing-assisted patient-specific instrument osteotomy guide in stiff clubfoot: preliminary findings. J Orthop Surg Res 2023; 18:843. [PMID: 37936150 PMCID: PMC10631177 DOI: 10.1186/s13018-023-04341-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The orthopedic treatment of the stiff clubfoot is challenging for clinicians, and the purpose of this study was to explore the preliminary findings of 3D printing-assisted patient-specific instrument (PSI) osteotomy guide for use in the orthopedic treatment of the stiff clubfoot. MATERIAL AND METHODS There were 20 patients (25 feet) with stiff clubfoot admitted from December 2018 to June 2022, including 13 males (16 feet) and 7 females (9 feet), aged 24-52 years, mean 40.15 years; 8 left feet, 7 right feet, 5 bipedal. All patients underwent triple arthrodesis and were divided into 10 cases (12 feet) in the PSI group (n = 12) and 10 cases (13 feet) in the conventional surgery group (n = 13) according to the surgical approach. The duration of surgery and the number of radiation exposures were recorded in all cases, and the American Orthopedic Foot and Ankle Society (AOFAS), and International Congenital Clubfoot Study Group (ICFSG) scoring systems were applied postoperatively to assess the effect of corrective treatment. All measurement data were expressed as mean ± standard deviation, and differences between groups were determined by Student's t test. All count data between the two groups were compared using the chi-square test or Fisher's exact test analysis. RESULTS All 20 patients (25 feet) were followed up for 1 year. No major complications related to osteotomy, such as overcorrection, incomplete correction, or bone nonunion, were observed in the PSI and conventional surgery groups at the final follow-up, and the PSI group had the advantage of shorter operative time (P < 0.01), less radiation exposure (P < 0.01), and higher excellent rate compared with the conventional surgery group. The AOFAS score (P > 0.05) and ICFSG score (P > 0.05) at the last follow-up were not statistically significant in both groups, but the excellent rate at the last follow-up was 91.7% in the PSI group which was significantly higher than that of the conventional surgery group at 76.9%. CONCLUSIONS The utilization of 3D printing-assisted PSI osteotomy guide in orthopedic surgery for stiff clubfoot offers a safe and effective surgical tool for triple joint fusion treatment. This technology simplifies surgical procedures, minimizes intraoperative radiation exposures, reduces surgical time, and enables precise and personalized treatment.
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Affiliation(s)
- Wei Liu
- The Affiliated Tumor Hospital of Xinjiang Medical University, Ürümqi, 830000, Xinjiang, People's Republic of China
| | - Siping Zhang
- The Sixth Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830000, Xinjiang, People's Republic of China
| | - Wenhao Zhang
- The Sixth Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830000, Xinjiang, People's Republic of China
| | - Fei Li
- The Sixth Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830000, Xinjiang, People's Republic of China
| | - Aihelamu Tueraili
- The Sixth Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830000, Xinjiang, People's Republic of China
| | - Ling Qi
- The Sixth Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830000, Xinjiang, People's Republic of China
| | - Chengwei Wang
- The Affiliated Tumor Hospital of Xinjiang Medical University, Ürümqi, 830000, Xinjiang, People's Republic of China.
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