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Management of Clubfoot by Joshi’s External Stabilization System (JESS)
BB Joshi, Ram Prabhoo, BG Kanaji, Sandhya Kaushik
1:
Classification and Evaluation of Clubfoot
CLASSIFICATION OF CLUBFOOT
Pandey's Classification
Carroll's Classification
Dimeglio's Classification
Catterall's Classification
International Clubfoot Study Group (ICFSG) Classification (Bensahel et al, 2005)
RADIOGRAPHIC EVALUATION OF CLUBFOOT
PHOTOGRAPHIC EVALUATION OF CTEV
2:
Joshi's Method of Conservative Management in Neonates
STAGES OF CLUBFEET CORRECTION
Stage 1: Axial Traction by Manipulation
Method of Manipulation in Neonates
Stage 2: Repositioning of Joints
Manipulation of Foot (After Lehman and Torok)
Equinus Correction
Static Splints for Maintenance of Correction after Manipulation
Alternative Method of Strapping the Thermoplastic Material in Young Children
Commercial Splint
Stage 3: Phase of Consolidation
Stage 4: Active Mobilization of the Foot
Stage 5: Rehabilitation
DISCUSSION
Advantages of the Method
Our Method
3:
Correction of CTEV by Controlled Differential Fractional Distraction Using JESS
JESS IN CTEV
THE PRINCIPLES OF CONTROLLED DIFFERENTIAL FRACTIONAL DISTRACTION
ASSESSMENT AND PLANNING
Indications for JESS
Preoperative Assessment (Clinical Assessment) (Caroll)
Radiological Assessment
Weight Bearing Footprints
PLANNING OF THE ASSEMBLY
Measuring the Foot Size
Measuring the Shin Size
Assembling a Trial Frame
INSTRUMENTATION AND COMPONENTS
Instrumentation
CTEV Assembly
Components
Link Joints
Universal Link Joints
Distraction Devices
The Double Hole Distractor
The Fish Mouth Distractor
The Split Block Distractor
The Biaxial Hinge Distractor
OPERATIVE TECHNIQUE
Insertion of K-wires
The Tibial K-wire Placement
The Metatarsal K-wire Placement
The Calcaneum K-wire Placement
The Creation of Holds
The Tibial Hold
The Metatarsal Hold
The Calcaneal Hold
The Connection Between Holds
The Tibio-metatarsal Connection
The Calcaneo-metatarsal Connection
The Tibio-calcaneal Connection
POSTOPERATIVE MANAGEMENT
Care of the Assembly
Distraction Schedule
The Calcaneo-metatarsal Distraction
The Tibio-calcaneal Distraction
The Tibio-metatarsal Connection
The Static Phase
Readjustment of the Frame
CLINICAL AND RADIOLOGICAL ASSESSMENT
Removal of the Assembly
Orthotic Devices
COMPLICATIONS
Temporary Edema
Superficial Pin Tract Infection
THE MERITS OF DISTRACTION TECHNIQUE
CASE ILLUSTRATION—CTEV CORRECTION BY JESS
STEP BY STEP DEMONSTRATION ON A MODEL FOR JESS CTEV ASSEMBLY
Operative Procedure
The Assembly
The Tibial Hold
The Metatarsal Hold
The Tibio-metatarsal Connection
The Calcaneal Hold
Calcaneo-metatarsal Connection
The Tibio-calcaneal Connection
Toe Sling Attachment
4:
Causes of Failure or Relapse of Clubfoot
FACTORS CAUSING FAILURE/RELAPSE
UNDER CORRECTED OR RELAPSED FOOT
5:
Dynamic Splinting for Residual Deformities and Early Recurrence
DYNAMIC AFO (ANKLE FOOT ORTHOSIS) AND REHABILITATIVE EXERCISE
Aim of Dynamic AFOs
MINOR ADDUCTION DEFORMITY OF THE FOREFOOT
Standard AFO Modified for External Rotation
Adoptive Method of Fixing the Above Knee Extension to the AFO for Older Children
FOR MORE PRONOUNCED FOREFOOT ADDUCTION DEFORMITY
FOR CORRECTION OF VARUS OF HEEL AT THE SUBTALAR REGION
Residual Deformity in Adolescent
ROCKER HEEL SPLINT FOR GAIT TRAINING AND TO CHECK INTOEING GAIT
SPLINT TO CORRECT TA CONTRACTURE
SPLINT FOR MULTIPLANAR CORRECTION—DYNAMIC KNEE ANKLE FOOT ORTHOSIS (KAFO)
BASIC SPLINT FOR CALCANEO PEDAL BLOCK
6:
Rehabilitative Exercises
EXERCISES
REHABILITATION EXERCISES FOR CLUBFOOT (SCHEMATIC REPRESENTATION)
7:
Comments and Frequently Asked Questions (FAQs)
COMMENTS AND VIEWS OF DR VM IYER, ms (ortho) ON QUESTIONS AND ANSWERS
QUESTIONS AND ANSWERS
CONCLUSION
MODIFICATIONS IN ORIGINAL ASSEMBLY
Modification in Frame Design
Tibial Hold
Modification in Calcaneum Hold
Forefoot Hold
Modification in Basic Component Design
Link Joints
Modular Distraction/Compression Units
Placement of Distractors
Modifications During the Correcting Phase
Modification during Static Phase
Modification during Post Correction Management
FURTHER READINGS
INDEX
TOC
Index
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