Bone deformities are often complex three-dimensional (3D) deformities, and correcting them is difficult. To correct persistent clubfoot deformity in adolescents or adults, an external fixator is sometimes used to encourage tissue growth and preserve healthy tissues. However, it is difficult to set up, resulting in long surgeries and steep learning curves for surgeons. It is also bulky and obstructs patient mobility. In this paper, we introduce a new approach of defining clubfoot deformity correction as a six degrees-of-freedom (6DOF) correction, and then reducing it to just two degrees-of-freedom (2DOF) using the axis-angle representation. Therefore, only two physical trajectory joints are needed, which in turn enables a more compact fixator design. A computer planner was developed to minimize the bulk of the external fixator, and to optimize the distraction schedule to avoid overstretching the soft tissues. This reduces the learning curve for surgeons and shortens surgery time. To validate the system, a patient-specific clubfoot simulator was developed, and four experiments were performed on the clubfoot simulator. The accuracy of midfoot correction was 11 mm and 3.5 deg without loading, and 41 mm and 11.7 deg with loading. While the external fixator has to be more rigid to overcome resistance against correction, the surgical system itself was able to achieve accurate correction in less than 2 h. This is an improvement from the current method, which takes 2.5–4.5 h.

References

References
1.
A.D.A.M., I.
,
2011
, “
Clubfoot
,” MedlinePlus, Bethesda, MD, accessed Aug. 19, 2013, http://www.nlm.nih.gov/medlineplus/ency/article/001228.htm
2.
Ponseti
,
I. V.
,
1992
, “
Treatment of Congenital Club Foot
,”
J. Bone Jt. Surg. Am.
,
74
(
3
), pp.
448
454
.
3.
Zionts
,
L. E.
,
2015
, “
What's New in Idiopathic Clubfoot?
,”
J. Pediatr. Orthop.
,
35
(
6
), pp.
547
550
.
4.
Zhao
,
D.
,
Li
,
H.
,
Zhao
,
L.
,
Liu
,
J.
,
Wu
,
Z.
, and
Jin
,
F.
,
2014
, “
Results of Clubfoot Management Using the Ponseti Method: Do the Details Matter? A Systematic Review
,”
Clin. Orthop. Relat. Res.
,
472
(
4
), pp.
1329
1336
.
5.
Radler
,
C.
,
Mindler
,
G. T.
,
Riedl
,
K.
,
Lipkowski
,
C.
, and
Kranzl
,
A.
,
2013
, “
Midterm Results of the Ponseti Method in the Treatment of Congenital Clubfoot
,”
Int. Orthop.
,
37
(
9
), pp.
1827
1831
.
6.
Dobbs
,
M. B.
,
Rudzki
,
J. R.
, and
Purcell
,
D. B.
,
2004
, “
Factors Predictive of Outcome After Use of the Ponseti Method for the Treatment of Idiopathic Clubfeet
,”
J. Bone Jt. Surg. Am.
,
86-A
(
1
), pp.
22
27
.https://www.ncbi.nlm.nih.gov/pubmed/14711941
7.
Ferreira
,
R. C.
, and
Costa
,
M. T.
,
2009
, “
Recurrent Clubfoot–Approach and Treatment With External Fixation
,”
Foot Ankle Clin.
,
14
(
3
), pp.
435
445
.
8.
Richards
,
B. S.
,
Faulks
,
S.
,
Rathjen
,
K. E.
,
Karol
,
L. A.
,
Johnston
,
C. E.
, and
Jones
,
S. A.
,
2008
, “
A Comparison of Two Nonoperative Methods of Idiopathic Clubfoot Correction: The Ponseti Method and the French Functional (Physiotherapy) Method
,”
J. Bone Jt. Surg. Am.
,
90
(
11
), pp.
2313
2321
.
9.
Morcuende
,
J. A.
,
Dolan
,
L. A.
,
Dietz
,
F. R.
, and
Ponseti
,
I. V.
,
2004
, “
Radical Reduction in the Rate of Extensive Corrective Surgery for Clubfoot Using the Ponseti Method
,”
Pediatrics
,
113
(
2
), pp.
376
380
.
10.
Luckett
,
M. R.
,
Hosseinzadeh
,
P.
, and
Ashley
,
P. A.
,
2015
, “
Factors Predictive of Second Recurrence in Clubfeet Treated by Ponseti Casting
,”
J. Pediatr. Orthop.
,
35
(
3
), pp.
303
306
.
11.
Zhao
,
D.
,
Liu
,
J.
,
Zhao
,
L.
, and
Wu
,
Z.
,
2014
, “
Relapse of Clubfoot After Treatment With the Ponseti Method and the Function of the Foot Abduction Orthosis
,”
Clin. Orthop. Surg.
,
6
(
3
), pp.
245
252
.
12.
Mayer
,
G.
,
Seidlein
,
H.
, and
Hunfeld
,
T.
,
1996
, “
Clubfoot Correction by External Ring Fixator
,”
Foot Ankle Surg.
,
2
(
4
), pp.
223
227
.
13.
El Barbary
,
H.
,
Abdel Ghani
,
H.
, and
Hegazy
,
M.
,
2004
, “
Correction of Relapsed or Neglected Clubfoot Using a Simple Ilizarov Frame
,”
Int. Orthop.
,
28
(
3
), pp.
183
186
.
14.
Hassan
,
A.
, and
Letts
,
M.
,
2012
, “
The Management of the Neglected Congenital Foot Deformity in the Older Child With the Taylor Spatial Frame
,”
J. Pediatr. Orthop.
,
32
(
1
), pp.
85
92
.
15.
Grill
,
F.
,
1989
, “
Correction of Complicated Extremity Deformities by External Fixation
,”
Clin. Orthop. Relat. Res.
,
241
, pp.
166
176
.https://www.ncbi.nlm.nih.gov/pubmed/2924459
16.
Franke
,
J.
,
Grill
,
F.
,
Hein
,
G.
, and
Simon
,
M.
,
1990
, “
Correction of Clubfoot Relapse Using Ilizarov's Apparatus in Children 8-15 Years Old
,”
Arch. Orthop. Trauma Surg.
,
110
(
1
), pp.
33
37
.
17.
Makhdoom
,
A.
,
Jokhio
,
M.
,
Qureshi
,
P. L.
, and
Siddiqui
,
K.
,
2012
, “
Resistant Clubfoot Deformities Managed by Ilizarov Distraction Histogenesis
,”
Indian J. Orthop.
,
46
(
3
), pp.
326
332
.
18.
Ganger
,
R.
,
Radler
,
C.
,
Handlbauer
,
A.
, and
Grill
,
F.
,
2012
, “
External Fixation in Clubfoot Treatment—A Review of the Literature
,”
J. Pediatr. Orthop. Part B
,
21
(
1
), pp.
52
58
.
19.
Suresh
,
S.
,
Ahmed
,
A.
, and
Sharma
,
V. K.
,
2003
, “
Role of Joshi's External Stabilisation System Fixator in the Management of Idiopathic Clubfoot
,”
J. Orthop. Surg.
,
11
(
2
), pp.
194
201
.
20.
Galante
,
V. N.
,
Molfetta
,
L.
, and
Simone
,
C.
,
1995
, “
The Treatment of Club Foot With External Fixation—A Review of Results
,”
Curr. Orthop.
,
9
(
3
), pp.
185
188
.
21.
Burns
,
J. K.
, and
Sullivan
,
R.
,
2004
, “
Correction of Severe Residual Clubfoot Deformity in Adolescents With the Ilizarov Technique
,”
Foot Ankle Clin.
,
9
(
3
), pp.
571
582
.
22.
Simpson
,
A. L.
,
Ma
,
B.
,
Slagel
,
B.
,
Borschneck
,
D. P.
, and
Ellis
,
R. E.
,
2008
, “
Computer-Assisted Distraction Osteogenesis by Ilizarov's Method
,”
Int. J. Med. Rob. Comput. Assisted Surg.
,
4
(
4
), pp.
310
320
.
23.
Hosny
,
G. A.
,
2002
, “
Correction of Foot Deformities by the Ilizarov Method Without Corrective Osteotomies or Soft Tissue Release
,”
J. Pediatr. Orthop. Part B
,
11
(
2
), pp.
121
128
.https://www.ncbi.nlm.nih.gov/pubmed/11943985
24.
Wu
,
Y. Y.
,
Rajaraman
,
M.
,
Lee
,
B.
,
Plakseychuk
,
A.
, and
Shimada
,
K.
,
2016
, “
A Patient-Specific Flexible 3D Printed Orthopedic Model for Training and Teaching of Clubfoot Correction Surgery
,”
3D Print. Addit. Manuf.
,
3
(
2
), pp.
98
105
.
25.
Bradski
,
G.
, and
Kaehler
,
A.
,
2008
,
Learning Opencv
,
1st ed.
,
O'Reilly Media
, Sebastopol, CA.
You do not currently have access to this content.