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Incidence and risk factors for iatrogenic distal tibia/fibula fracture during Ponseti technique of clubfoot treatment

Ranjan, Rahula; Sud, Alokb; Adhikary, Debashisc; Sinha, Abhinavb; Chand, Sureshb

Journal of Pediatric Orthopaedics B: November 2019 - Volume 28 - Issue 6 - p 572–578
doi: 10.1097/BPB.0000000000000595
Foot & Ankle

The incidence and risk factors of distal tibia/fibula fracture, an uncommon complication during Ponseti manipulation, are unknown. We evaluated 222 virgin clubfeet of patients aged less than 3 years for fractures of distal tibia/fibula. Incidence rate was found to be 1.3% per year. Associated risk factors were identified as neglected, syndromic clubfeet, feet requiring greater than 10 casts, post-tenotomy dorsiflexion less than 10° and casting by physician with less than 3 years of casting experience, with odds ratios of 14, 28, 4.9, 3.7 and 3.4, respectively. Most of these fractures healed without consequences; however, it is still advisable not to forcefully dorsiflex while casting, which may result in the fracture of distal tibia/fibula.

aAll India Institute of Medical Sciences, Patna, Bihar

bLady Hardinge Medical College, New Delhi

cMax Hospital, Patparganj, Delhi, India

Correspondence to Rahul Ranjan, MS, Department of Orthopaedics, All India Institute of Medical Sciences, Patna 801507, Bihar, India, Tel: + 91 852 716 3750; e-mail:

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