Turco's 15-year, single-surgeon series of 240 resistant clubfeet treated with one-stage posteromedial release and internal fixation. The study examines how age at surgery, prior operations, and technical modifications affect long-term outcomes. It also introduces dual Kirschner wire fixation to prevent postoperative overcorrection.
The Turco release remains a landmark because it codified what failure actually looks like in clubfoot surgery — not bad technique at the table, but correctable errors in timing, fixation, and postoperative casting.
When planning surgery, target ages 1–2 years. If a family presents with a 9-month-old whose casting has failed, the data support waiting rather than rushing to the OR. The failure rate below 12 months (15.8%) is nearly 7 times higher than in the 1–2 year window (2.3%).
When you reopen a previously operated foot, set expectations early: excellent results drop from 46% to 27% and failures nearly triple. The scarring from even a simple Achilles lengthening significantly complicates the dissection.
After wire removal in children under 3, use an above-knee cast with the knee at 90 degrees. Below-knee casts alone failed in 4 of the 8 recurrence cases in this series. This is a fixable, preventable failure mode.
Turco's 15-year, single-surgeon series of 240 resistant clubfeet treated with one-stage posteromedial release and internal fixation. The study examines how age at surgery, prior operations, and technical modifications affect long-term outcomes. It also introduces dual Kirschner wire fixation to prevent postoperative overcorrection.
The Turco release remains a landmark because it codified what failure actually looks like in clubfoot surgery — not bad technique at the table, but correctable errors in timing, fixation, and postoperative casting.
When planning surgery, target ages 1–2 years. If a family presents with a 9-month-old whose casting has failed, the data support waiting rather than rushing to the OR. The failure rate below 12 months (15.8%) is nearly 7 times higher than in the 1–2 year window (2.3%).
When you reopen a previously operated foot, set expectations early: excellent results drop from 46% to 27% and failures nearly triple. The scarring from even a simple Achilles lengthening significantly complicates the dissection.
After wire removal in children under 3, use an above-knee cast with the knee at 90 degrees. Below-knee casts alone failed in 4 of the 8 recurrence cases in this series. This is a fixable, preventable failure mode.