Abstract
The outcomes of the Berman-Gartland osteotomy in 26 feet (20 children) from 1995 to 1999 were evaluated. Average age at time of operation: 8 years, 3 months (range 37 to 194 months). Average age at follow-up: 2 years, 5 months (range 2 to 70 months).
The osteotomy is performed in tourniquet from three lengthwise incisions and fixed by Kirschner wires and plaster of Paris for six weeks. Only patients with idiopathic PEC were included in this study. Average age at time of primary operation was ten months. For analysis, the type and percentage of preceding operations were: pantalar release (40%), posterior release (12%), and tendo calcaneus elongation (8%). Eight feet (30%) were not primarily surgically treated. Indicated for metatarsal osteotomy were: footwear difficulty (92%), gait instability (65%), and muscle spasm (56%). Average adduction deformity of the forefoot was clinically assessed as 30 degrees (20 to 45 degrees). Forefoot rigidity was evaluated according to Black as grade II (14 feet) and grade III (12 feet).
Radiograph assessment was made by the use of T-I.MTT and C-V.MTT angle changes in the dorsoplantar weight-bearing view. We succeeded in correcting the average values of T-I.MTT angle from 28 degrees (range 20 to 43 degrees) preoperatively to 4 degrees (range 2 to 15 degrees) postoperatively, and C-V.MTT angle from 16 degrees (range 8 to 24 degrees) to 2 degrees (range -5 to 7 degrees). Isolated metatarsal varus deformity was found in 12 feet, in combination with talo-navicalar joint hypercorrection in nine feet, and in combination with residual talo-navicular joint subluxation in five feet.
Calcaneocuboid joint displacement was classified as grade I and II in 16 and 3 feet respectively. Preoperative residual displacement was not found in seven feet.
Complications were noted in three metatarsal nonunions (2% of 130 osteotomized metatarses), four pin migrations, one superficial infection, and one persistent forefoot swelling.
At final follow-up, clinical findings and outcomes were assessed as excellent in 16 feet (62%) and good in 10 feet (38%). We recorded no inferior result. An apparent relationship was not found between the type and timing of preceding operations and varus forefoot deformity persistence. In 19 feet (73%), residual grade I and grade II tibial subluxation of the cuboid bone was found.
The abstracts were prepared by David P. Davlin. Correspondence should be addressed to him at the Orthopedic Clinic Bulovka, Budínova 2, 18081 Prague 8, Czech Republic.
