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Management of Flexion knee Deformity Using a Circular Frame

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Acute correction of flexion knee contracture with soft tissue release, osteotomy ... Gradual treatment of knee flexion contracture using a circular frame is an ... – PowerPoint PPT presentation

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Title: Management of Flexion knee Deformity Using a Circular Frame


1
Management of Flexion knee Deformity Using a
Circular Frame
1Gamal Hosny, MD 2Mohamed Fadel, MD From
Department of Orthopedic Surgery, 1Benha Faculty
of Medicine and 2El-Minia Faculty of Medicine,
Egypt fadelminia_at_yahoo.com
Acute correction of flexion knee contracture with
soft tissue release, osteotomy or both may lead
to serious complications. The aim of this
prospective study was to evaluate the role of a
circular frame in treating gradually fixed
flexion knee deformity.
Material Methods All cases referred to our
center since 1994 with fixed flexion knee
deformity 25 degrees or more 56 were treated
with a circular frame except CP
myelomeningocoele cases. Six cases were excluded.
The age at operation ranged from 2-19 ys average
11.5y.All operations were performed by the first
author. There were 21 bilateral and 29 unilateral
cases 71 knee. There were 28females.The
aetiology was AMC in 16cases, lumbosacral
agenesis in 2 cases, traumatic in 10 cases,
fibular hemimelia in 3 cases, tibial hemimelia in
3 cases, congenital short femur in 5 cases, fused
knee in 2 cases, polio in 8 cases and multiple
pterygium syndrome in 1 case. Associated
problems as foot deformities or shortening were
evident in 50 of cases. Ilizarov external
fixator was applied to the femur tibia and
gradual distraction was applied posteriorly with
proper hinge positioning. The frame was modified
to deal with other associated problems. The
bloodless technique was applied in all cases
except if there was bony fusion. In these cases
osteotomy was performed followed by gradual
distraction. Evaluation depended upon the
following parameters knee flexion angle,
activity level, ROM, stability, pain and patient
satisfaction.
Results After an average follow up 3ys and 8ms
range 1-8y, the angle of flexion improved from
an average of 68 preoperatively range 25-140 to
13.5range 0-75.The average time in the fixator
was 4 months. Out of the 20 bilateral nonwalkers
preoperatively, 11 could walk using orthosis and
7 became independent walkers. There was no
functional deterioration in the rest of the
cases. Magnitude of lengthening ranged from 4-8
cm.
  • Complications included
  • some sort of pin tract infection in all cases.
  • Fractures related to the fixator in 7 cases.
  • Knee subluxation in 3 cases.
  • Knee stiffness in 2 cases.

Fig 1 a case of lumbosacral agenesis with
bilateral knee flexion which had been treated
using the bloodless technique
Conclusion Gradual treatment of knee flexion
contracture using a circular frame is an
effective method. It can correct other associated
deformities. Recurrence of the deformity is
dependant upon the aetiology and not the type of
treatment.
Fig 2 a case of post-surgical knee flexion
deformity with posterior subluxation which had
been treated by gradual distraction
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