Early results of clubfoot management by Joshi's external stabilizing system

Abstract

Introduction: With the use of Ponseti's technique, majority of children with clubfoot do not need operative treatment; however, some severe clubfoot including neglected, recurrent, and resistant forms cannot be managed by conservative methods and needs surgical intervention. The foot becomes rigid with soft tissue surgery, and bony operations can make the foot even more smaller. To avoid it, a simple alternative is to use joshi's external stabilising system (JESS) and distractor components which are used on the principle of controlled differential fractional distraction histogenesis. JESS distractors allow gradual distraction of contracted soft tissues and align all the joints of the foot so as to bring corrections of all aspects of deformity of the foot simultaneously. Purpose: To analyze the role of JESS fixator in correcting case of clubfoot in terms of cosmetic, functional, and anatomical outcome which were assessed by International Clubfoot Study Group (ICFSG) scores. Materials and Methods: Total of 6 Clubfoot underwent differential fractional distraction in AIIMS, Raipur. Patients were assessed preoperatively for morphology and functionality and radiologically by ICFSG score. Period of correction varied from 5 to 8 weeks. Once correction is obtained, then apparatus is locked in that position for the same period and later converted to cast in plantigrade for maintenance and followed up regularly. The results were analyzed with ICFSG score. Results: Excellent to good results were obtained in all the cases which were assessed by ICFSG score. There were only minor complications in patients. Conclusion: JESS frame is simple, versatile, and best suited for correcting clubfoot deformities which were neglected, resistant, and recurrent.

Keywords

• clubfoot
• differential distraction
• joshi's external stabilising system