61: Older Clubfoot with Osteotomy Treated with MAC External Fixator

Fig. 1

(a–c) Pre-operative photograph demonstrating severe clubfoot in spite of previous corrective efforts

Fig. 2

Pre-operative dorsal-plantar radiograph demonstrating CAVE deformity

3 Preoperative Problem List

Midfoot and forefoot plantar flexion and varus deformity

4 Treatment Strategy

The pre-operative plan included right foot one-level application of the Biomet multiaxial correction (MAC) external fixation system with lateral column closing wedge osteotomy of the calcaneus.

5 Basic Principles

The use of the MAC external fixator allows for correction and adjustment of angular deformity and displacement in all three planes, including correction of residual or secondary deformities that occur during lengthening. The fixator can correct lower extremity deformities, including clubfoot, and allows the possibility of anatomic alignment within normal radiographic limits. Correction could be accomplished here with one MAC fixator on the midfoot bisector. The deformities can be corrected via a CORA-centric or CORA-perpendicular application. Correction can be accomplished through soft tissues if the joints are intact or osteotomy if the joints are degenerated and bone growth disturbances have occurred (Davidson 2011). An opening wedge osteotomy can avoid shortening an already small foot. The advantages of external fixation for clubfoot deformity are gradual correction, preservation of joints, correction through bone around deformed joints, post-operative adjustability, and reduced risk to nerves and vessels. Furthermore, if the osteotomy is not at the center of rotation of angulation (CORA), the external fixator can translate to compensate.