3+4+Supplementum/2012 - Společnost pro pojivové tkáně

Postoperative management
z Postoperative Rehabilitation is a must
z The child is tutored in activities requiring
lateral pulp and chuck pinch
z Occasionally, dynamic splinting to assist
a tendon transfer is appropriate.
Conclusions
Upper extremity surgery can be
rewarding and beneficial in probably
selected patients with cerebral palsy. Only
few hands disabled by cerebral palsy can
be helped by surgery. Early surgery may
shorten the period for physical therapy.
limited improvement can be expected
never enough to produce a nearly normal
hand.
aBSTRakT
MeTHOdS Of TReaTMenT Of
CluBfOOT. ReView Of MeTHOdS
(1954–2012). ReSulTS Of
TReaTMenT
Jacek Karski, Jerzy Ostrowski, Leszek Gil, Jarosław
Kałakucki, Tomasz Karski
introduction
Since the Orthopedic Department in
Lublin in 1954 (7. 12. 1954) was created up
to the present time – orthopaedic surgeon
in Lublin deals very often with treatment
of children with clubfoot. Especially since
the creation of the Department of Pediatric
Orthopedics IP AM (1.10.1970) researches
and publications have been more frequent
and bring lot of new values.
336 14 th Prague-Sydney-Lublin
Material and method
The material from the Pediatric
Orthopedic and Rehabilitation Department
have been analyzed with details on material
from years 1970 – 2000. In the years 1970 –
2000 we have treated surgically with Turco
method with the own modifications: 1080
children, 1315 feet, 706 boys, 374 girls. We
distinguished according to the descriptions
of Dimeglio four types of feet deformations.
These are: soft-soft, soft-stiff, stiffsoft
and stiff-stiff. In our Department we
also distinguished “pure” (or “exclusive”)
clubfoot – congenital deformity and clubfoot
– and other group with the neurogenic
component (5 % – 8 % such cases).
This second group is particularly difficult
to treat. From 1954 (the creation of the
Orthopaedic Department in Lublin) to
1975 clubfoot treatment – was carried out
according to the old concept and has been
difficult, long and not very effective. In the
50’s and 60’s of the twentieth century has
always planned (at the outset), two or three
operational stages program (posterior and
medial capsulotomy, Achilles tendon, TP,
FHL, FDL tendons elongation, TA transfer)
and such “repetitions”.
From 1975 to 2012 only about 10% –20%
of children requires a full “operational programm”
and requires operator experience
and perfection. Now (1995–2012) – from
80% to 90% of children we are able to heal
the feet without any surgery.
Principles of treatment
We present them at points: 1. early beginning
of conservative corrections (manipulations
and plastering) – from the first/
second day after birth, 2. removal of deformation
according to the order – a) adduc-