Gradual distraction for treatment of severe knee flexion contractures using the Ilizarov’s apparatus

Authors

  • Ajay Deep Sud Department of Orthopaedics, Armed Forces Medical College, Pune, Maharashtra, India
  • Rajiv Kaul Department of Orthopaedics, Armed Forces Medical College, Pune, Maharashtra, India http://orcid.org/0000-0002-6870-9206
  • Manish Prasad Department of Orthopaedics, Armed Forces Medical College, Pune, Maharashtra, India
  • Hrishikesh Pande Department of Orthopaedics, Base Hospital, Lucknow, Uttar Pradesh, India
  • Vivek M. Philip Orthopaedic Surgeon, Level 3 Indian Field Hospital, Goma, Congo, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20193837

Keywords:

Knee contractures, Flexion deformity, Gradual distraction, Ilizarov apparatus

Abstract

Background: Knee flexion contractures result in a significant amount of functional disability due to reduced mobility and limb length discrepancy. Treatment options include non-surgical methods like serial casting, dynamic splinting and traction or surgical methods like osteotomies and soft tissue procedures. External fixation has emerged as a highly successful means of achieving controlled gradual correction of joint contractures with low rates of complications including recurrence. The aim of this study is to evaluate the functional outcome in terms of residual deformity and change in ambulatory status following correction using the Ilizarov’s apparatus.

Methods: 12 patients with knee flexion contractures ranging from 20°-70° underwent correction using the Ilizarov’s external fixator (IEF). The use of simple mathematic formulae enabled us to calculate and estimate the rate and duration of distraction. End results were assessed at one year by the residual contracture as: Excellent: 0-5°, Good: 6-15°, Fair: 16-30° and Poor: >30°.

Results: The functional assessment was graded as excellent in 7, good in 4 and fair in 1 out of 12 patients. All patients were independent ambulators and only 1 out of 12 patients required an additional orthosis for maintenance of the correction.

Conclusions: The IEF is a safe and precise modality even for the most complex contractures of the knee. Accurate placement of the hinges along the center of rotation of the knee avoids undue subluxation of the tibia during correction. In order to ensure a low rate of complications, it is imperative to have a detailed pre-operative plan and all principles of fixation should be meticulously adhered to. 

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Author Biographies

Ajay Deep Sud, Department of Orthopaedics, Armed Forces Medical College, Pune, Maharashtra, India

Professor and Head,

Department of Orthopaedics

Armed Forces Medical College

Pune, Maharashtra

Rajiv Kaul, Department of Orthopaedics, Armed Forces Medical College, Pune, Maharashtra, India

Senior Resident

Department of Orthopaedics

Armed Forces Medical College

Pune, Maharashtra

Manish Prasad, Department of Orthopaedics, Armed Forces Medical College, Pune, Maharashtra, India

Associate Professor

Department of Orthopaedics

Armed Forces Medical College

Pune, Maharashtra

Hrishikesh Pande, Department of Orthopaedics, Base Hospital, Lucknow, Uttar Pradesh, India

Associate Professor

Department of Orthopaedics

Base Hospital, Lucknow

Vivek M. Philip, Orthopaedic Surgeon, Level 3 Indian Field Hospital, Goma, Congo, India

Orthopaedic Surgeon,

Level 3 Indian Field Hospital
Goma, Congo

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Published

2019-08-26

How to Cite

Sud, A. D., Kaul, R., Prasad, M., Pande, H., & Philip, V. M. (2019). Gradual distraction for treatment of severe knee flexion contractures using the Ilizarov’s apparatus. International Journal of Research in Orthopaedics, 5(5), 929–935. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20193837

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Section

Original Research Articles