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Charles-Lozoya S, Cobos-Aguilar H, Alvarado-Alanis JL, De la Parra-Márquez ML, Salas-Delgado A, Segoviano-Mendoza MA, Arriaga-Cazares HE, Montes-Cruz JV. Reproducibility of pop sensation, Thompson sign in achillotomy, and final Pirani score to predict clubfoot relapse: Achillotomy clinical signs and Pirani predictive ability. Medicine (Baltimore) 2024; 103:e38377. [PMID: 38875390 PMCID: PMC11175865 DOI: 10.1097/md.0000000000038377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/06/2024] [Accepted: 05/06/2024] [Indexed: 06/16/2024] Open
Abstract
Ultrasound (US) can guide and confirm percutaneous release of the achilles tendon in the clubfoot. However, this technique may not always be available; therefore, surgeons' reported feelings of tendon release ("click" or "pop") and the Thompson sign could demonstrate that they are sensitive and reliable for confirming complete tendon release. The purpose of this study was to compare the reproducibility of clinical maneuvers that aim to detect the reported "click" or "pop" sensation by the surgeon and the Thompson sign after surgical release in percutaneous achilles tenotomy compare with US in patients with clubfoot. A cross-sectional reproducibility study of consecutive patients with idiopathic clubfoot was conducted. All the patients were scheduled to undergo tenotomy in the operating room using the standard percutaneous achilles tenotomy technique under sedation. The surgeon's reported surgical sensation ("click" or "pop") and Thompson signs were compared to the US assessment of the cut. The final Pirani score was used to predict recurrence risk and was correlated with the number of plaster casts and age. Forty-five feet were affected in 30 patients. Eighteen (60%) men. Age range: 1 to 60 months. The sensation of "click" or "pop" was recorded in 38 patients, and complete release was confirmed by US in 37 patients, for a sensitivity (Se) of 0.95 and specificity (Sp) of 0.63. Thompson signs were positive in 33 and 36 patients at 2 evaluations, with Se values of 0.87 and 0.92 and Sp values of 0.88 and 0.75, respectively. The Pirani final score, a predictor of recurrence risk, had an area under the curve of 0.80 (95% CI = 0.63-0.97; P = .005), Se = 0.78, and Sp = 0.56, with a cutoff point of 2.75. The feeling of achilles tendon release and Thompson sign had high sensitivity, prevalence, accuracy, and posttest probability. The confirmation of tendon release based on clinical signs could prevent the use of US.
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Affiliation(s)
- Sergio Charles-Lozoya
- Health and Research Science Management, Pediatric Orthopedic Surgery, Division of Plastic and Reconstructive Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Monterrey, NL, Mexico
- Health Science Division, Vice-rectory of Health Science, Universidad de Monterrey, San Pedro Garza Garcia, NL, Mexico
| | - Héctor Cobos-Aguilar
- Health Science Division, Vice-rectory of Health Science, Universidad de Monterrey, San Pedro Garza Garcia, NL, Mexico
| | - Jorge Luis Alvarado-Alanis
- Coordination of the Doctorate of Medical Sciences, Universidad Juárez del Estado de Durango, Durango, Durango, Mexico
| | - Miguel Leonardo De la Parra-Márquez
- Health and Research Science Management, Pediatric Orthopedic Surgery, Division of Plastic and Reconstructive Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Monterrey, NL, Mexico
| | | | - Marcela Araceli Segoviano-Mendoza
- Health and Research Science Management, Pediatric Orthopedic Surgery, Division of Plastic and Reconstructive Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Monterrey, NL, Mexico
| | - Héctor Eliud Arriaga-Cazares
- Health and Research Science Management, Pediatric Orthopedic Surgery, Division of Plastic and Reconstructive Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Monterrey, NL, Mexico
| | - Jocelyn Verónica Montes-Cruz
- Health and Research Science Management, Pediatric Orthopedic Surgery, Division of Plastic and Reconstructive Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Monterrey, NL, Mexico
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Li J, Xun F, Xu C, Li Y, Xu H, Canavese F, Xia H. Early Radiographic Characteristics of the Lateral Talocalcaneal Angle and its Predictive Significance for Relapse in Patients With Idiopathic Clubfoot Treated With the Ponseti Method. J Foot Ankle Surg 2024:S1067-2516(24)00108-X. [PMID: 38866200 DOI: 10.1053/j.jfas.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 04/16/2024] [Accepted: 05/19/2024] [Indexed: 06/14/2024]
Abstract
In order to evaluate the early radiographic characteristics of the lateral talocalcaneal (L-TC) angle in patients with idiopathic clubfoot (ICF) and to investigate its prognostic significance for relapse after initial treatment with the Ponseti method. We retrospectively included 151 patients (96 males and 55 females; 227 feet) with ICF treated at our Institution between January 2005 and December 2014. The age at initial treatment was less than 6 months, and radiographs were obtained within 3 months of the Achilles tenotomy (mean age: 2.3 months; range: 0.77-6.8). All patients were followed up for at least 7 years (range, 7-18). The participants' feet were classified into 3 groups: relapsed (Group A), not relapsed (Group B), and normal foot groups which consisted of healthy feet in patients with unilateral ICF (Group C). All angle measurements were expressed in degrees. Forty-seven ICF feet in 33 patients relapsed, while 180 feet in 118 patients did not, and the age at relapse was 5.92 ± 1.91 years. Seventy-five normal feet were included in Group C. The average L-TC angle in Group A and B patients was 33.57° ± 12.05° and 39.37° ± 12.55°, respectively, while Group C was 49.61° ± 9.11°. A significant difference was found among the 3 groups of patients (F = 31.48, p < .001). The L-TC angle cut-off value below which a recurrence could be predicted was 36.1° (sensitivity, 74.47%). The L-TC angle of ICF patients treated using the Ponseti method were reduced compared to normal feet. An L-TC angle of <36.1° has relative value in predicting ICF relapse.
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Affiliation(s)
- Jingchun Li
- Department of Paediatric Orthopaedics, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Fuxing Xun
- Department of Paediatric Orthopaedics, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Chenchen Xu
- Department of Paediatric Orthopaedics, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yiqiang Li
- Department of Paediatric Orthopaedics, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hongwen Xu
- Department of Paediatric Orthopaedics, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Center, Jeanne de Flandre Hospital, Lille, France; Orthopedic and Traumatology Department, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy; DISC-Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, University of Genova, Viale Benedetto XV N°6, 16132, Genova, Italy
| | - Huimin Xia
- Department of Paediatric Orthopaedics, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, Guangdong, China.
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Barik S, Agarwal A. Non-zero Pirani score in corrected clubfoot due to empty heel: A prognostic dilemma. J Clin Orthop Trauma 2023; 47:102295. [PMID: 38196502 PMCID: PMC10772365 DOI: 10.1016/j.jcot.2023.102295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 11/07/2023] [Accepted: 11/22/2023] [Indexed: 01/11/2024] Open
Abstract
Purpose The aim of this study was to track the correction of individual components of Pirani scoring system (PSS) over the manipulation and tenotomy phase of Ponseti casting method in idiopathic clubfoot. Additionally, non-zero PSS scores were analysed to find out the residual deformities. Methods The included feet were assessed initially according to the six component PSS. The individual scores of each component of midfoot and hindfoot were scored at each visit till the final follow up. The final scoring was done before the start of the bracing phase of the feet (with or without tenotomy). Results Evaluation was performed for 42 feet in 28 infants (14 bilateral) with mean age of 42.5 ± 39.2 days (range, 15-150 days). All the six components of PSS showed a significant change from the first cast till the pre tenotomy cast. Post tenotomy, there was a significant change in the scores of posterior crease (0.4 ± 0.2 to 0.1 ± 0.1, p < 0.001) and rigid equinus (0.8 ± 0.3 to 0.1 ± 0.2, p < 0.001). 66.7 % (28/42) of the feet had an abnormal empty heel sign of either 0.5 [22/42 (52.3 %)] or 1 [6/42 (14.4 %)] at initiation of bracing. Conclusions The individual components of Pirani scoring system changed to a variable extent as the treatment progressed. Curvature lateral border and talar head reached normalcy prior to tenotomy. Posterior crease and rigid equinus showed a significant reduction after tenotomy. The non-zero empty heel component may require careful interpretation both post treatment and during follow ups.
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Affiliation(s)
- Sitanshu Barik
- Orthopedics, All India Institute of Medical Sciences, Nagpur, India
| | - Anil Agarwal
- Pediatric Orthopedics, Chacha Nehru Bal Chikitsalaya, Delhi, India
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Pavone V, Vescio A, Culmone A, Caldaci A, Rosa PL, Costarella L, Testa G. Interobserver Reliability of Pirani and Dimeglio Scores in the Clinical Evaluation of Idiopathic Congenital Clubfoot. CHILDREN-BASEL 2021; 8:children8080618. [PMID: 34438509 PMCID: PMC8392791 DOI: 10.3390/children8080618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Dimeglio (DimS) and Pirani (PirS) scores are the most common scores used in congenital talipes equinovarus (CTEV) clinical practice. The aim of this study was to evaluate the interobserver reliability of these scores and how clinical practice can influence the clinical outcome of clubfoot through the DimS and Pirs. METHODS Fifty-four feet were assessed by six trained independent observers through the DimS and PirS: three consultants (OS), and three residents (RS) divided into three pediatric orthopaedic surgeons (PeO) and three non-pediatric orthopaedic surgeons (NPeO). RESULTS The PirS and DimS Scores were strongly correlated. In the same way, OS and RS, PirS, and DimS scores were strongly correlated, and the interobserver reliability ranked "good" in the comparison between PeO and NPeO. In fully trained paediatric orthopaedic surgeons, an "excellent" interobserver reliability was found but was only "good" in the NPeO cohort. CONCLUSIONS In conclusion, after careful preparation, at least six months of observation of children with CTEV, PirS and DimS proved to be valid in terms of clinical evaluation. However, more experience with CTEV leads to a better clinical evaluation.
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Gelfer Y, Hughes KP, Fontalis A, Wientroub S, Eastwood DM. A systematic review of reported outcomes following Ponseti correction of idiopathic club foot. Bone Jt Open 2020; 1:457-464. [PMID: 33215139 PMCID: PMC7667221 DOI: 10.1302/2633-1462.18.bjo-2020-0109.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIMS To analyze outcomes reported in studies of Ponseti correction of idiopathic clubfoot. METHODS A systematic review of the literature was performed to identify a list of outcomes and outcome tools reported in the literature. A total of 865 studies were screened following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and 124 trials were included in the analysis. Data extraction was completed by two researchers for each trial. Each outcome tool was assigned to one of the five core areas defined by the Outcome Measures Recommended for use in Randomized Clinical Trials (OMERACT). Bias assessment was not deemed necessary for the purpose of this paper. RESULTS In total, 20 isolated outcomes and 16 outcome tools were identified representing five OMERACT domains. Most outcome tools were appropriately designed for children of walking age but have not been embraced in the literature. The most commonly reported isolated outcomes are subjective and qualitative. The quantitative outcomes most commonly used are ankle range of motion (ROM), foot position in standing, and muscle function. CONCLUSIONS There is a diverse range of outcomes reported in studies of Ponseti correction of clubfoot. Until outcomes can be reported unequivocally and consistently, research in this area will be limited. Completing the process of establishing and validating COS is the much-needed next step.Cite this article: Bone Joint Open 2020;1-8:457-464.
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Affiliation(s)
- Yael Gelfer
- St George’s University of London, UK
- St George’s Hospital, London, UK
- Sheffield Teaching Hospital NHS Trust, Sheffield, UK
| | | | | | - Shlomo Wientroub
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Orthopaedics, Dana Children’s Hospital – Tel Aviv Medical Center, Tel Aviv, Israel
| | - Deborah M. Eastwood
- Great Ormond Street Hospital, London, UK
- Paediatric Orthopaedics, University College London, London, UK
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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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