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Surgical indication:
o
Tachdjian:
Tachdjian:
Apley
Delaying surgery until the child is near walking age has the
advantages of operating on a larger foot (making surgery easier)
and using the forces in normal walking to help maintain the
correction obtained at surgery.
ATL pada kasus CTEV. Kaki dari Z incision pada bagian distal mengarah ke medial (Campbell)
Turco:
McKay:
Posterior capsules of the ankle and subtalar joints often have to be divided
to allow adequate correction of hindfoot equinus
Sometimes flexor digitorum longus and flexor hallucis longus also require
attention.
TURCO
Supine position
curved posteromedial incision beginning alongside the Achilles tendon above the
ankle joint
the posterior tibialis tendon being lengthened or released, the talonavicular joint
opened dorsally, medially, and inferiorly, and the calcaneonavicular spring
ligament released. The Achilles tendon and long toe flexors are lengthened and
repaired. The talonavicular joint is reduced and pinned
Immobilized his patients for a total of 4 months and removed the K-wires at 6
weeks. Night splints were used for an additional year after the end of cast
immobilization.
CARROL (Tachdjian)
Position: prone/supine
Posteromedial:
calcaneocuboid joint is opened from the medial side and fully released
Posterolateral:
Posterior longitudinal incision paralleling the lateral edge of the heel cord
Reduce the talonavicular joint, by internally rotating the talus with a longitudinal
K-wire as the handle to perform this derotation
Incision (Lovell) circumferential incision around the posterior aspect of the foot
several millimeters above the posterior crease
Carry incision posteriorly, curve beneath the distal end of the medial malleolus
and ascending slightly to pass transversely over the Achilles tendon
approximately at the level of the tibiotalar joint
Continue the incision in a gentle curve over the lateral malleolus, and end it just
distal and slightly medial to the sinus tarsi
RELEASE (Tachdian):
The majority of peritalar structures, including all hindfoot and midfoot joints,
Once the calcaneus has been adequately derotated by pushing the anterior end
laterally and the posterior tuberosity medially and downward, the interosseous
ligament is internally fixed.
McKay also introduced the concept of an articulated cable cast in which the
hinge is centered at the ankle joint for immediate postoperative movement, with
the connection between the foot and leg portions of the cast being large-gauge
telephone wire. This was intended to increase hindfoot (ankle) motion, with 30 to
60 degrees of total motion being reported
Wound complications from early motion of the cable cast have decreased
acceptance of this method of postoperative management.