IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 10 Ver. V (October. 2016), PP 15-19 www.iosrjournals.org DOI: 10.9790/0853-1510051519 www.iosrjournals.org 15 | Page Role of Jess in Management of Neglected, Relapsed And Resistant Ctev Sachin Yadav 1 , Dharmendra Yadav 1 , Ravi Prakash Sahai 1 , Manish Shukla 1 1 Department Of Orthopedics, M.L.N Medical College, Allahabad, U.P, India. Abstract Aim: To evaluate the role of Joshi’s external stabilization system in the management of neglected, resistant and relapsed CTEV, in the age group of 1-10 years. Methods And Material: Total 18 patients (20 feet’s) underwent JESS fixation surgery at Department of Orthopedics, S.R.N.Hospital, M.L.N. Medical College Allahabad, from January 2012 to July 2015. This prospective study was conducted on every third patient coming with neglected, relapsed or resistant CTEV in OPD of Orthopedics Results: The clinical correction of the deformity was assessed using Dimeglio's classification system. The maximum clinical correction was seen in equinus deformity, followed closely by calcaneo-forefront block deformity. The deformities, which responded least, were varus and forefoot adduction deformities. 95% of the patients were in grade I or grade II. Conclusion: Correction by JESS fixator has distinct advantage of fractional distraction which appears to be effective method of management irrespective of the severity of the deformity. Keywords: neglected, relapsed, resistant, distraction I. Introduction Understanding the patho-mechanics of clubfoot and treating it successfully has always been a daunting task for modern medicine .The present day recommendations are of starting gentle passive manipulations of the deformed foot soon after birth and applying corrective cast at about 2-3 weeks. The cast is changed every 1-2 week and at each cast change, the foot is gently and gradually manipulated till full correction is achieved. The foot is subjected to soft tissue corrective surgery as soon as it becomes clear that the deformity is not responding to a fair trial of this conservative treatment. The management of relapsed or neglected clubfoot unlike that of virgin cases is even more challenging because with time the deformities become fixed and the feet develops secondary adaptive bony changes. These feet usually are not amenable to correction by soft tissue release procedures alone and often need some bony procedures as well. However, bony procedures (closing wedge osteotomy, arthrodesis) lead to further shortening of an already smaller foot of CTEV. Especially for these cases presenting late or after relapse, which constitute quite a major proportion of clubfoot patients in developing countries like India, another treatment option has emerged from bony procedures towards ring external fixator system based on principle of fractional distraction histogenesis of G.A. Ilizarov 1 .However in order to successfully use the tensioned wires required of Ilizarov fixator, child must have attained the age of 3 years because prior to this age there is insufficient strength in cartilaginous analogue of tarsal bones. Dr. B. B. Joshi 2 of Mumbai based on this principle has developed a simpler construct for the correction of clubfoot deformities known as JESS (Joshi's external stabilizing system), which can be used even in children below three years of age because it doesn't use tensioned wires. The present study was taken up to assess the results of JESS fixator in correction of deformities in neglected, resistant or relapsed cases of CTEV. II. Material And Methods This study was conducted after taking the clearance of ethical committee of M.L.N. Medical College & associated hospital. The present study included patients coming with neglected relapsed and resistant CTEV in OPD of department of Orthopedics, M.L.N. Medical College & associated hospital between january12 and July 2015. Inclusion criteria: a) Idiopathic CTEV of neglected, resistant or relapsed type in age group 1 to 10 yrs. b) Patients with no neurological deficit. c) Patients with no vascular compromise in affected foot.