Guest guest Posted March 29, 2000 Report Share Posted March 29, 2000 , Dr. Dietz refers to the " Little operation " and the " Big operation. " (Little being tendon transfer.) Is this thing you just posted related to the " Big " ??? I'm not clear what the procedure is that you are showing stats on. I agree 18% seems awfully big failure, what is considered a " bad " failure rate among other operations, such as heart bypass or gall removal, for example, to put this into perspective? Thanks. shawnee Turco procedure > > > > (sorry about the fumble fingers on last post) > > Turco method (posteromedial release surgery) eight year followup yields > this kind of result. > > 38.9% excellent, 26.9% good, 15.6% fair, and 18.6% failure. > > > 18.6% failure?!? And this after only EIGHT years! Why in the world is > surgery considered the FIRST course of action with this kind of failure > rate when more successful treatments are available?! > > > Sorry, had to vent. > > Masoner > > ------------------------------------------------------------------------ > LOW RATE, NO WAIT! > Get a NextCard Visa, in 30 seconds! Get rates > as low as 2.9% Intro or 9.9% Fixed APR and no hidden fees. > Apply NOW! > http://click./1/2122/2/_/675489/_/954347366/ > ------------------------------------------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 29, 2000 Report Share Posted March 29, 2000 ee wrote: > , Dr. Dietz refers to the " Little operation " and the " Big operation. " > (Little being tendon transfer.) Is this thing you just posted related to > the " Big " ??? I'm not clear what the procedure is that you are showing > stats on. I agree 18% seems awfully big failure, what is considered a " bad " > failure rate among other operations, such as heart bypass or gall removal, > for example, to put this into perspective? The Turco procedure is a posteromedial release operation. The surgeon makes a big cut from the ankle to the middle of the foot, lengthens several tendons and ligaments, and removes some joint tissue. Removing joint tissue " loosens up " the joints so that the foot can be moved into a corrected position. The main problem seems to be that removing the joint tissue is what probably causes stiffness later in life. Ponseti and Dietz favor something called " talar release " when surgery is required. I don't know much about talar release (yet). I found a presentation which compares the Turco method with something called the " Complete Subtalar Release " (CSR) which may or may not be what Dietz and Ponseti do. This study reports that 20% of patients undergoing Turco correction had unsatifactory results after eight years, which compares with the 18% figure I found in the other study. Only 1 out of 15 patients that were corrected with CSR required further surgery, and that was only to correct an overcorrection. The mean followup for the second procedure was just over three years. The summary seems to suggest that further followup was unnecessary on the CSR-treated patients, and the authors note that CSR " presented fewer risk of recurrent or residual deformities than the Turco's release. " The summary is at http://www.afcp.net/EFAS_97.html Search in the web page for " Comparaison of postero-medial and subtalar Release in surgical Treatment of resistant Clubfoot. " That page, BTW, is a goldmine of information about the current state-of-the-art in clubfoot treatment. I know that Dietz is recommending surgery for ; it probably won't be the Turco procedure. I empathize with what you're going through and I am praying that things will turn out favorably for you, your family, and . It's a hard thing to consider surgery for a two-year-old. I don't know what Dietz is talking about regarding litle and big operations. I can speculate that the little operation might be the talar release, and the big operation might be a tendon transfer or even something really major like an athrodesis, in which the bones of the foot are fused together. These major things typically aren't done until later in life, though. Regarding the 18% failure rate of the Turco procedure, this is in contrast to other methods of treating clubfoot which are available that we are aware of :-) (such as physiotherapy, which unfortunately seems not to have worked for , and other non-surgical methods, and even the CSR procedure I describe above.) AFAIK, gall removal and heart bypass surgeries are ineffective in treating clubfoot :-) :-) :-) , feel free to correct any misinformation I have here. :-) Masoner Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 29, 2000 Report Share Posted March 29, 2000 > I don't know what Dietz is talking about regarding litle and big > operations. I can speculate that the little operation might be the > talar release, and the big operation might be a tendon transfer or even > something really major like an athrodesis, in which the bones of the > foot are fused together. These major things typically aren't done until > later in life, though. > > Regarding the 18% failure rate of the Turco procedure, this is in > contrast to other methods of treating clubfoot which are available that > we are aware of :-) (such as physiotherapy, which unfortunately seems > not to have worked for , and other non-surgical methods, and even > the CSR procedure I describe above.) AFAIK, gall removal and heart > bypass surgeries are ineffective in treating clubfoot :-) :-) :-) > > , feel free to correct any misinformation I have here. :-) > > Masoner and ee, I think that Dr. Dietz's " little " operation is the anterior tibial tendon transfer. It is done if there are repeated relapses and the child is over 2 years of age so that the bones have calcified. Supposedly about 25% of our children will need this procedure which risk can be reduced, although probably not eliminated, by religious use of the shoes w/bar. Dr. Ponseti's method prefers this because it avoids surgery into the ankle joint which is where the motion of the foot occurs. But also Dr. Ponseti's long term study includes all of their patients (treated from near birth with their method), whether they had to have the " big " or " little " surgery or no surgery. I think that one of the reasons that Ponseti method doctors so emphaize the shoes with bar is that it's use can help to avoid relapses especially within the first 2 years of life when only some form of the " big " surgery is an option. I think that the " big " surgery would be release types of operations that go into the ankle joint. Even for the Ponseti method where 5% of children need this (instead of 60-95% with other doctors), the Ponseti method tries to minimize the amount of things that need to be done inside the ankle joint area. Because of using the Ponseti method of manipulaiton and casting, they can do fewer things than would be done otherwise by more surgically oriented doctors. From what I have read in surgically oriented clubfoot treatment books, there are about 25 different things that can be done during the big surgery that fall within the definitions of posterior, medial, posteriormedial, lateral, plantar and circumferential releases and tarsometatarsal capsulotomies. These things are defined a bit in the wheeless textbook of othropedics that can be located through H's links page. Even just the posterior release typically includes an open incision lengthening of the achilles tendon as well as up to 4-5 other procedures involing ligaments and joints. From the surgically oriented clubfoot books I have (where some form of the big surgery is their main treatment method), one chapter references 9 prior clubfoot treatment outcome studies and indicated that relapses or complications after a 1st big surgery occured from 13-50% of the time with their stating that 25% was the average. It appears that 2nd and subsequent surgeries from the traditional methods groups can be repeats of some part of the original surgery and/or procedures involving cutting bones (called osteotomies). In Dr. Ponseti's book, he indicates that with their method, they don't need to do bone surgeries (from my memory without having the book in front of me). Also, as far as comparisons to the outcomes of other studies. The ways that each study is done in not on a universally accepted system of rating severity or results so it is hard to compare results from any two studies. So to some degree the referenced " Turco " method study only really applies to the hospital or doctors that did the treatment and produced the study, although it should encourage them to look to finding better methods. I think that a " BIG " surgery done at a surgically oriented hospital is going to be quite a bit different and involve more than a " big " surgery done by a Ponseti method doctor (when they are done.) From Dr. Ponseti's book, " A comparison between the results of our long term follow-up studies of our severe cases (with the exclusion of mild cases necessitating fewer than four plaster-cast changes for correction) and those of short term follow up studies in other clinics is not appropriate because our results address correction of the deformity emphasizing patient atisfaction and painless functional performance into adult life: our treatment is primarily manipulative with limited surgery to maintain the correction in the more severe cases. In other clinics treatment is primarily surgical including extensive joint release operations usually after a period of inadequate manipulation and cast treatment that fails to correct the deformity. " Dr. Ponseti states, " Furthermore, evaluation schemes 'lack a universally accepted rating system for assessment of results' as Cummings et al (1994) have warned. " There is a lot of other information in the book that deals with these types of issues. Also, these are just my opinions from what I have read and those I have talked to. I may have somewhat misunderstood some of these issues. and (3-17-99) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 29, 2000 Report Share Posted March 29, 2000 OK smart ass. I just wondered if 18% was a high failure rate with Surgery-In-General across the board regardless of the body part affected.... The tendon transfer is definately the " " Small " operation, in what Dietz says. What the " Big " one is, I dunno. ~~~* Re: Turco procedure > > > > > I don't know what Dietz is talking about regarding litle and big > > operations. I can speculate that the little operation might be the > > talar release, and the big operation might be a tendon transfer or > even > > something really major like an athrodesis, in which the bones of the > > foot are fused together. These major things typically aren't done > until > > later in life, though. > > > > Regarding the 18% failure rate of the Turco procedure, this is in > > contrast to other methods of treating clubfoot which are available > that > > we are aware of :-) (such as physiotherapy, which unfortunately > seems > > not to have worked for , and other non-surgical methods, and > even > > the CSR procedure I describe above.) AFAIK, gall removal and heart > > bypass surgeries are ineffective in treating clubfoot :-) :-) > :-) > > > > , feel free to correct any misinformation I have here. :-) > > > > Masoner > > > and ee, > > I think that Dr. Dietz's " little " operation is the anterior tibial > tendon transfer. It is done if there are repeated relapses and the > child is over 2 years of age so that the bones have calcified. > Supposedly about 25% of our children will need this procedure which > risk can be reduced, although probably not eliminated, by religious > use of the shoes w/bar. Dr. Ponseti's method prefers this because it > avoids surgery into the ankle joint which is where the motion of the > foot occurs. But also Dr. Ponseti's long term study includes all of > their patients (treated from near birth with their method), whether > they had to have the " big " or " little " surgery or no surgery. I > think that one of the reasons that Ponseti method doctors so emphaize > the shoes with bar is that it's use can help to avoid relapses > especially within the first 2 years of life when only some form of > the " big " surgery is an option. > > I think that the " big " surgery would be release types of operations > that go into the ankle joint. Even for the Ponseti method where 5% > of children need this (instead of 60-95% with other doctors), the > Ponseti method tries to minimize the amount of things that need to be > done inside the ankle joint area. Because of using the Ponseti > method of manipulaiton and casting, they can do fewer things than > would be done otherwise by more surgically oriented doctors. > > >From what I have read in surgically oriented clubfoot treatment > books, there are about 25 different things that can be done during > the big surgery that fall within the definitions of posterior, > medial, posteriormedial, lateral, plantar and circumferential > releases and tarsometatarsal capsulotomies. These things are defined > a bit in the wheeless textbook of othropedics that can be located > through H's links page. Even just the posterior release > typically includes an open incision lengthening of the achilles > tendon as well as up to 4-5 other procedures involing ligaments and > joints. > > >From the surgically oriented clubfoot books I have (where some form > of the big surgery is their main treatment method), one chapter > references 9 prior clubfoot treatment outcome studies and indicated > that relapses or complications after a 1st big surgery occured from > 13-50% of the time with their stating that 25% was the average. It > appears that 2nd and subsequent surgeries from the traditional > methods groups can be repeats of some part of the original surgery > and/or procedures involving cutting bones (called osteotomies). In > Dr. Ponseti's book, he indicates that with their method, they don't > need to do bone surgeries (from my memory without having the book in > front of me). > > Also, as far as comparisons to the outcomes of other studies. The > ways that each study is done in not on a universally accepted system > of rating severity or results so it is hard to compare results from > any two studies. So to some degree the referenced " Turco " method > study only really applies to the hospital or doctors that did the > treatment and produced the study, although it should encourage them > to look to finding better methods. I think that a " BIG " surgery done > at a surgically oriented hospital is going to be quite a bit > different and involve more than a " big " surgery done by a Ponseti > method doctor (when they are done.) > > >From Dr. Ponseti's book, " A comparison between the results of our > long term follow-up studies of our severe cases (with the exclusion > of mild cases necessitating fewer than four plaster-cast changes for > correction) and those of short term follow up studies in other > clinics is not appropriate because our results address correction of > the deformity emphasizing patient atisfaction and painless functional > performance into adult life: our treatment is primarily manipulative > with limited surgery to maintain the correction in the more severe > cases. In other clinics treatment is primarily surgical including > extensive joint release operations usually after a period of > inadequate manipulation and cast treatment that fails to correct the > deformity. " > > Dr. Ponseti states, " Furthermore, evaluation schemes 'lack a > universally accepted rating system for assessment of results' as > Cummings et al (1994) have warned. " > > There is a lot of other information in the book that deals with these > types of issues. Also, these are just my opinions from what I have > read and those I have talked to. I may have somewhat misunderstood > some of these issues. > > and (3-17-99) > > > ------------------------------------------------------------------------ > LOW RATE, NO WAIT! > Get a NextCard Visa, in 30 seconds! Get rates > as low as 2.9% Intro or 9.9% Fixed APR and no hidden fees. > Apply NOW! > http://click./1/2122/2/_/675489/_/954366520/ > ------------------------------------------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 29, 2000 Report Share Posted March 29, 2000 ee wrote: > OK smart ass. I just wondered if 18% was a high failure rate with > Surgery-In-General across the board regardless of the body part affected.... I was being very insensitive in some of my remarks. I'm sorry about that. Masoner Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 29, 2000 Report Share Posted March 29, 2000 Oh hey, don't be, I can take a joke good as the next guy! If my skin is that thin, I probably need heart by-pass or something! LOL! s. Re: Turco procedure > > > ee wrote: > > > OK smart ass. I just wondered if 18% was a high failure rate with > > Surgery-In-General across the board regardless of the body part affected.... > > > I was being very insensitive in some of my remarks. I'm sorry about > that. > > Masoner > > ------------------------------------------------------------------------ > Get a NextCard Visa, in 30 seconds! > 1. Fill in the brief application > 2. Receive approval decision within 30 seconds > 3. Get rates as low as 2.9% Intro or 9.9% Fixed APR > Apply NOW! > http://click./1/2646/2/_/675489/_/954368328/ > ------------------------------------------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
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