Jurga Grybauskaitė-Rudalevičienė, Viktorija Brogaitė, Kęstutis Saniukas
Background: Valgus deformity of the hindfoot in cerebral palsy (CP) patients and patients suffering from myelomeningocele is common and causes functional deterioration and shoe fitting problems together with skin ulcerations. Our aims in this study are to present an intra-articular modified Dennyson-Fulford technique of subtalar fusion using allograft and internal fixation with canulated screw to achieve stabilization and to report the radiological results and clinical outcome. We also compared the clinical results in two groups of cases ( in one of them we performed a modified subtalar Dennyson-Fulford intra-articular arthrodesis, in another – modified Dennyson-Fulford arthrodesis together with aditional operation). Methods: We performed a retrospective review of radiographs and medical records of 20 patients (27 cases) with CP who underwent intraarticular modified Dennyson-Fulford subtalar fusion from January 2003 to December 2012. The subtalar joint was fixed through the anterior facet with a cannulated screw whereas the anterior aspect of the calcaneus was parallel to the anterior aspect of the head of the talus. Bicortical iliac crest allograft was placed into the sinus tarsi and the denuded posterior facet area. Results are grouped as good, satisfactory, and poor according to the radiographic and clinical outcomes. Results: The mean age at the time of surgery was 11,4 ± 1,3 years (range: 9 to13y) and the average follow-up was 21,5 ± 23 months ( range: 1,5mo to 60mo). Good results were obtained in 5 cases (asymptomic feet with stable desis), satisfactory results were obtained in 7 cases (feet were in neutral position after the operation, pseuarthrosis was observed in some radiographs, but the functional ability of the patients was unaffected). Poor results were reported in 5 cases ( reccurence of the deformity, no desis, skin and shoe problems were obvious). We also compared the results in two groups of cases ( in the first one, the additional operation was performed together with the modified Dennyson-Fulford intra-articular arthrodesis: Achilles tendon was lenthened in 6 cases, gastrocnemius recession was performed in 5 cases, in 3 cases peroneus longus and brevis lenthening was performed and in one case – talonavicular desis). In the second group of cases the only operation performed was the modified Dennyson-Fulford subtalar arthrodesis. There were 82% good and satisfactory results in the first group of cases and 50% in the second one. Poor results were obtainded in 18% between the first case group and in 50% – in the second one. Conclusions: We obtained 70% of good and satisfactory results in correction of neuromuscular „planovalgus“ deformity while using modified Dennyson-Fulford subtalar arthrodesis technique. A statistically significant change in the average of almost all the angle values was stated after the operation, while evaluating the radiological results. Better results were obtained in the case group with additional operation performed together with modified Dennyson-Fulford operation. Subtalar intra-articular modified Dennyson-Fulford technique is a safe and reliable method of neuromuscular „planovalgus“ deformity correction.
Keyword(s): neuromuscular „planovalgus“ deformity; cerebral palsy; myelomeningocele; intra-articular subtalar arthrodesis
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