Treatment of severe flexion deformity of the knee in children and adolescents using the Ilizarov technique. J Bone Joint Surg Br
We have used the Ilizarov technique for severe flexion deformity of the knee in 11 patients (13 knees) between 1986 and 1994 and have followed them up for an average of 4.1 years. The age of the patients at operation ranged from 1.7 to 18.8 years. The femoral and tibial components were connected by two anterior hinges, medial and lateral, and two posterior distraction rods. The deformity was corrected to a femorotibial lateral shaft angle of less than 20 degrees. A permanent orthosis was applied after removal of the fixator. Fractures occurred in four patients and paralysis of the common peroneal nerve in another. There was a recurrence of the deformity in four patients. At the last review all patients were able to walk on their operated leg with or without an orthosis. We have found the Ilizarov method to be helpful in correcting severe fixed flexion deformity of the knee, with relatively few complications, but the basic principles of the method must be carefully followed.
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[Show abstract] [Hide abstract] ABSTRACT: Congenital longitudinal deficiency of the tibia is a rare and often syndromic anomaly. Amputation is usually the preferred treatment option in complete absence of the tibia; however, a conservative management might be implemented in partial forms or in case of amputation refusal. Our experience with the Ilizarov fixator, convinced us this device was the best suited for progressive correction of lower limbs length discrepancies and articular or bone angular limb deformities (ALD). The aim of this study is to highlight the interest of the Ilizarov fixator in the multistage conservative treatment of congenital tibial deficiencies. A retrospective study was conducted in nine patients suffering from Type I or II congenital tibial deficiencies (Jones) and sequentially managed using the Ilizarov technique. The functional outcome after treatment completion was then clinically assessed. The different stages of correction were recorded for each individual patient. Patients were assessed at a mean follow-up of 18,3 years (4-32 years). The mean maximum knee flexion was 35 degrees (0 degrees -90 degrees ) in type I deficiencies and 118 degrees (90 degrees -140 degrees ) in type II deficiencies. One patient underwent amputation and a bilateral knee arthrodesis was performed in another case. Few series in the literature report a comparable length of follow-up period in the conservative management of severe congenital tibial deficiencies. In our study, the Ilizarov fixator provided satisfactory progressive corrections of severe congenital tibial deficiencies. Level IV therapeutic retrospective study.0Comments 10Citations
- "The timing and staging of these procedures vary according to the surgeon. In the light of our experience with the Ilizarov fixator, this method appears highly efficient in the progressive correction of lower limb length discrepancies and articular or bony angular deviations . The aim of that study was to demonstrate the interest of the Ilizarov external fixator in the multistage conservative management of congenital tibial deficiencies. "
[Show abstract] [Hide abstract] ABSTRACT: IntroductionVarious treatment options are in use to address severe knee flexion contractures in children. Their success depends on an adequate selection of the proper one applying to each individual anatomical situation.HypothesisApplied to limb deformity, the Ilizarov technique combines progressive correction, to joint structures flexibility restitution in case of severe knee flexion contracture. We review a continuous series of popliteal pterygium syndrome patients managed with this technique.Patients and methodsMedical records of eight children (11 knees), consecutively treated between 1986 and 2007, were reviewed. Knee flexion ranged from 40 to 120°. Contracture (> 90°) was extremely severe in 10 cases. Progressive correction was gained by Ilizarov external fixation. Complications during and following articular chain distraction-lengthening were noted. Follow-up ranged from 1 to 21 years.ResultsSurgical realignment was rendered particularly complex by the popliteal cutaneous band itself, partly responsible of the joint stiffness and sciatic nerve shortening. Deformities were corrected by the Ilizarov technique. Complete extension was obtained in all cases. In six cases, flexion contracture reccurrence required to repeat the correction, using the same technique, at a mean interval of 3–4 years. During follow-up, four evolutive partial posterior tibial dislocations and one complete dislocation were diagnosed, all associated with recurrence of the flexion contracture.Level of evidence: Level IV. Therapeutic Study.0Comments 2Citations
- "This technique may be indicated in severe periarticular retraction when the aim is to provide the child with a limb in extension to enable walking  . The progressive nature of the reduction enables continuous distension of capsule-ligamentary, tendinous and vasculonervous com- ponents . The cutaneous retractions—–bands and webs, however extensive—–are also suppled, circumventing the need for covering or cutaneous expansion plasty. "
[Show abstract] [Hide abstract] ABSTRACT: Unlabelled: The purpose of this study was to report the results of the surgical treatment of spastic knee flexion contracture using tenotomy and progressive correction by external fixator-distractor devices. The study design involved a prospective observational study of 16 knees in nine patients with spastic flexion contracture greater than 30 degrees . Treatment was indicated for both ambulatory and nonambulatory patients; and, in the latter group when sitting or personal hygiene was compromised. The average age was 11.6 years (range 10-17). Five of the patients were male and four female. There was one case of hemiplegia (11.1%), two cases of paraplegia (22.2%), and six cases of quadriplegia (66.7%). Six patients retained some walking capacity, while three had none. In all cases, distal lengthening of the hamstrings was carried out. A monolateral fixator with a gradual correction device was applied for a period of 4.8 weeks. The average follow-up was 26.6 months. The preoperative straight-leg raise was 55 degrees . The popliteal angle was 58 degrees preoperatively (range 30-80 degrees ), 8.5 degrees on removal of the fixator, and 20 degrees at the end of the follow-up. Complications: There were no superficial or deep infections, and no fractures or distal sensory-motor alterations. There was one case of arthrodiatasis of the knee (6.3%) which was resolved when the fixator was removed, and 11 cases of pin-track infection (68.7%) which were resolved with local care and oral antibiotics. To conclude, spastic knee flexion contracture can be treated gradually with monolateral external fixator with distraction devices, and with distraction modules which prevent acute stretching of the posterior neurovascular structures of the knee.0Comments 2Citations
- "It appears that the sciatic nerve does not tolerate elongations, especially when abruptly applied, of more than 5–12% of its length without injury [20, 38]. This has prompted the use of Ilizarov external fixation systems with progressive correction mechanisms as an alternative strategy [27, 29, 30, 32]. Published results are good but include miscellaneous pathologies such as congenital pterygium, arthrogryposis, haematological or septic problems, myelomeningocele, burns, and tumours. "