OBJECTIVE: To investigate the effectiveness of applying a standardized rehabilitation process in correction of adult clubfoot with the Ilizarov technique. METHODS: Thirty-eight adult patients who underwent orthopedic treatment with Ilizarov technique for clubfoot between August 2022 and December 2024 were retrospectively analyzed. The patients were divided into a study group and a control group with 19 cases in each group according to the different rehabilitation management processes and methods. The differences in baseline data such as gender, age, side, and preoperative Holden walking function grading between the two groups were not significant ( P>0.05). In both groups, most of the clubfoot deformities were surgically corrected first, and the residual deformities were corrected by dynamic slow retraction with Ilizarov ring-type external fixation frame. The study group adopted standardized rehabilitation process management mode, including preoperative lower limb muscle strength training, postoperative pain and swelling management, weight-bearing management, gait and lower limb stability training. The control group adopted the conventional postoperative rehabilitation management mode. The occurrence of complications was recorded, including pin tract infection, ankle stiffness and pain, and deformity recurrence. Holden walking function grading was used to evaluate the walking ability of the patients. Clinical efficacy was evaluated by the QIN Sihe Deformity Correction Disability Repair and Functional Reconstruction Postoperative Efficacy Evaluation Scale. Patient satisfaction was evaluated by Likert score. RESULTS: Patients in both groups successfully completed surgery and rehabilitation and were followed up. The follow-up time ranged from 8 to 29 months, with a mean of 18.5 months. Among them, the follow-up time was (18.8±5.5) months in the study group and (18.2±5.7) months in the control group, and the difference between groups was not significant ( t=0.316, P=0.754). The postoperative incidences of pin tract infection, ankle stiffness and pain, and deformity recurrence in the study group were 10.53%, 5.26%, and 5.26%, respectively, and in the control group were 21.05%, 36.84%, and 15.79%, respectively. And the difference between groups in the incidence of ankle stiffness and pain was significant ( P=0.042). At last follow-up, both groups showed an improvement in Holden walking function grading compared to preoperative levels ( P<0.05), and the grading of the study group was significantly higher than that of the control group ( P=0.006). According to the QIN Sihe Deformity Correction Disability Repair and Functional Reconstruction Postoperative Efficacy Evaluation Scale, the grade difference between groups was not significant ( P=0.089), and the excellent and good rates of clinical efficacy in study group and control group were 89.47% (17/19) and 73.68% (14/19), respectively. Patient satisfaction in study group was significantly better than that in control group ( P=0.036). CONCLUSION Standardized rehabilitation process can effectively promote the postoperative functional recovery of adult clubfoot treated with Ilizarov technique, reduce the risk of complications and improve effectiveness.
Humans ; Ilizarov Technique/rehabilitation* ; Clubfoot/rehabilitation* ; Male ; Female ; Retrospective Studies ; Adult ; Treatment Outcome ; Young Adult ; Weight-Bearing ; Adolescent

The treatment of massive bone and soft tissue defect in the lower leg has a high complication rate of nonunion, chronic infection, and amputation without well-vascularized tissue coverage of the open fracture. Despite adequate free soft tissue coverage, massive skeletal defect may result in segmental bone defects, angulation deformity, and limb length discrepancies. In the last decade, major advances have occurred in the Ilizarov method of distraction osteogenesis in lower leg salvage as a delayed procedure or simultaneous distraction after free-tissue transfer. The authors have performed Ilizarov transport in conjunction with muscle and musculocutaneous flap coverage in nine cases of lower leg salvage. The flaps consist of rectus, gracilis, latissimus dorsi, parascapular, and serratus muscle or musculocutaneous fashioning using ipsilateral or contralateral pedicle in consideration of vessel condiation. Revision, recorticotomy and flap elevation were also used as a secondary procedure for satisfactory results. The conclusions, were as follows: 1) Multidisciplinary team approach with conjoining departments at the time of preoperative evaluation, postoperative care and rehabilitation care; 2) Muscle flap covered with split-thickness skin graft was preferred to musculocutaneous flap; 3) To reduce the total reconstructive period, simultaneous free tissue transfer with Ilizarov distraction should be considered.
Amputation ; Congenital Abnormalities ; Extremities ; Fractures, Open ; Ilizarov Technique ; Leg* ; Myocutaneous Flap ; Osteogenesis* ; Osteogenesis, Distraction ; Postoperative Care ; Rehabilitation ; Skin ; Superficial Back Muscles ; Transplants

The introduction and adaptation of the methods of Ilizarov could be achieved correction of equines in patients with major problems such as posttraumatic equines associated with severe soft tissue injury that would not allow the use of conventional surgical methods. In order to evaluate the factors causing complications and affecting the results, we reviewed 12 cases in which the equines deformity of feet were corrected by the Ilizarov method from May 1991 to August 1995. Mean follow up periods were 18 months. The average age of patients was 28 years(ranged from 8 to 56 years). The causes of equines were posttraumatic 9, Charcot-Marie-Tooth disease 1, residual poliomyelitis 1, and deformity of unknown origin 1, and four cases were associated varus deformity. Correction periods was from 4 to 14 weeks(average 7 weeks), fixation period from 1 to 16 weeks(average 6.2 weeks). The additional immobilization with cast or brace was from 4 to 44 weeks, and then rehabilitation was done. Initial equines deformity was averaged 39.5 degrees (range 20-70 degrees). We obtained average 33 degrees of deformity correction which means the average 6.5 degrees of equines still was remained at the last follow up. Range of motion was improved from preoperative 11 to postoperative 20 degrees. One posttraumatic patient with calcaneal varus and loss of calf muscles, and one residual poliomyelitis patient recurred during follow up. We performed the triple arthrodesis and Achilles lengthening in one case of Charcot-Marie-Tooth disease and one case of equines deformity of unknown origin. Gait pattern and pain was improved in all but 2 cases with mild pain in walking. Complications during or after treatment were recurrence(2), anterior subluxation of talus(5), claw toe(10), partical rupture of Achilles tendon(1), valuges or varus deformity (4), posterior tibial nerve injury(1), rockerbottom deformity(2) and pin tract infection(5). The case of recurrence or second operation coourred in 4 of 12 cases(33%). To prevent the recurrence of equines deformity, we recommend that long period of maintainance, adequate cast immobilization or brace more than 3 months, and continuous rehabilitation. The key to prevent subluxation of talus was a precise hinge placement at the center of talar dome and, if subluxation of talus was occurred, it should be corrected by anterior or posterior translation using olive pin. It should be corrected by flexor tendon lengthening during correction period or after removal of Ilizarov, if claw toew deformity occurred.
Animals ; Arthrodesis ; Braces ; Charcot-Marie-Tooth Disease ; Congenital Abnormalities ; Equinus Deformity ; Follow-Up Studies ; Foot ; Gait ; Hoof and Claw ; Humans ; Ilizarov Technique ; Immobilization ; Muscles ; Olea ; Poliomyelitis ; Range of Motion, Articular ; Recurrence ; Rehabilitation ; Rupture ; Soft Tissue Injuries ; Talus ; Tenotomy ; Tibial Nerve ; Walking