Variations in clubfoot management exist among orthopedic surgeons in North America
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CHICAGO — Results presented at the American Academy of Orthopaedic Surgeons Annual Meeting showed variations in cast material, bracing method, tenotomy indications and practices exist among orthopedic surgeons for clubfoot management.
Oliver Sax, DO, MS, and colleagues assessed demographics and background education of clubfoot providers, clubfoot management, and clubfoot outcomes and complications among all members of the Pediatric Orthopaedic Society of North America through a 23-question survey.
“Only 7.3% of the POSNA members responded that they were clubfoot practitioners, and they were mostly from Texas, California and Canada,” Sax said in his presentation here. “Most were MDs, had over 30 years of practice experience and taught at a major teaching hospital or medical school and practiced at a university hospital.”
Sax noted more than 50% of participants reported attending clubfoot training courses. He added respondents reported using between four and seven casts for 1-week duration, with approximately 70% casts composed of plaster and approximately 30% of casts composed of a semi-rigid construct.
Respondents most commonly used Denis-Browne and Mitchell-Ponseti braces, according to Sax. Results showed respondents used an array of anesthesia when tenotomy was indicated, including local injection, numbing gels and general sedation. Sax noted respondents primarily performed tenotomy in the OR, clinic or office.
“Regarding the outcomes and complications of clubfoot management, over 50% used a cast saw for removal and reported a 5.5% of incidence of cast burn,” Sax said. “However, most did not use any device to prevent these burns.”
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Herzenberg JE, et al. Paper 440. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. March 22-26, 2022; Chicago.
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