The Open Orthopaedics Journal

ISSN: 1874-3250 ― Volume 14, 2020

The Combined Lambrinudi and Ankle Arthrodesis with Ring External Fixation in the Long-term Severe Neuromuscular Equinocavovarus Deformity with Ankle and Hindfoot Osteoarthritis: The Cases Presentation and Modified Guideline of Treatment

Prasit Rajbhandari1, 2, Chayanin Angthong1, *, Jiancheng Zang3, Sihe Qin3, Andrea Veljkovic4
1 Department of Orthopaedics, Faculty of Medicine, Thammasat University Pathum Thani, 12120 Thailand
2 Orthopaedics Department, Manmohan Memorial Teaching Hospital, Kathmandu, Nepal
3 Qinsihe Orthopedic Institute Orthopaedics department of Chinese National Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids (NRRA, Beijing, China)
4 Department of Orthopaedic Surgery, University of British Columbia, Vancouver, Canada



Severe equinocavovarus deformity develops from various causes and generally results in major disability that affects patient’s mobility and quality of life. It can be divided into neuromuscular and non-neuromuscular deformities, including two major subtypes: i.e., paralytic and spastic. In addition, ankle osteoarthritis could be caused by prolonged or progressive foot deformity.


The present report proposes a modification of the accepted treatment algorithm and Lambrinudi’s surgical technique with ankle and hindfoot arthrodesis to correct theses challenging deformities with the long-term condition.


Two equinocavovarus cases were included, one in a 54-year old male and the second in a 63-year old female with paralaytic and spastic etiologies respectively. Patient’s deformity correction was acceptable. Each patient demonstrated improved outcomes due to a postoperative plantigrade foot and ankle position. No significant complications were encountered during the course of care and last follow-up. The mean follow-up time was 26 months.


Severe long term neuromuscular equinocavovarus deformities are a challenging disability in the foot and ankle surgery. The present article proposes a modified guideline of treatment illustrated in two representative case studies of long-term paralytic and spastic equinocavovarus deformities. These conditions can be treated surgically using the stepwise approach as demonstrated in this article with acceptable outcomes.

Article Information

Identifiers and Pagination:

Year: 2019
Volume: 13
First Page: 183
Last Page: 188
Publisher Id: TOORTHJ-13-183
DOI: 10.2174/1874325001913010183

Article History:

Received Date: 20/06/2019
Revision Received Date: 30/07/2019
Acceptance Date: 19/09/2019
Electronic publication date: 30/09/2019
Collection year: 2019

© 2019 Rajbhandari et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Foot and Ankle Surgery Unit, Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand, Tel: 662-926-9775; Fax: 662-926-9793; E-mail:

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