Arthrogryposis multiplex congenita (AMC) refers to a group of conditions, unrelated to one another, which are similarly characterized by the contracture of multiple joints in the body. One of the common therapies in patients with AMC and knee extension contracture is quadricepsplasty. However, no comprehensive studies have been conducted on the results of the application of this method. This prospective study included 14 patients (9 females and 5 males) with 23 hyperextension contractures of the knee. Before surgery, all patients had underwent non-surgical treatment (manipulation and serial casting) for at least 6 months, but none had responded to the treatment. Then patients underwent a Quadricepsplasty. Range of motion (ROM) of the knee and patients ambulation based on modified form of Functional Mobility Scale (FMS) before and after surgery were evaluated in a follow up 3 years. The mean passive knee ROM before surgery was 7.17° (0° to 15°), which increased to 65.65° (35° to 105°) after the operation. According to t-test results, this increase was statistically significant (P<0.005). The mean ambulation score (modified FMS) of the patients before surgery was 1.57, which increased to 3.71. According to t-test results, this increase was statistically significant (P<0.005). Quadricepsplasty is the method of choice for the surgical treatment of knee extension contracture in AMC patients, who do not respond to non-surgical treatments. This method leads to a significant improvement in knee ROM. On the other hand, it preserves quadriceps strength at 4/5 level, and finally, along with other therapeutic interventions for other lower limb deformities, leads to ambulation improvement in these patients.

Abstract:Background: Femoral neck fractures are rare in children. This type of fracture usually originates from high energy traumas. This fracture has serious complications and one of the most disabling one is avascular necrosis. The goal of this research is active follow up of patients in order to decide about the rate of late complications, patient `s function after surgery and residual pain. Methods: In this five year study 35 patients were evaluated and different parameters studied. These parameters included: age, sex, side of fracture, mechanis of injury, type of reduction, rate and type of complication followed surgery. Results: In general, femoral neck fractures are more common between 16 and 20.It is two fold common in females than males and it was more common in left side. The most common mechanisms was falling. Treatment methods were open reduction in 88 % and close reduction in 12%.The most common type of fractures was type3. Following treatment, 60% of patients remained uncomplicated and 40% had complication. In fact limitation in internal and external rotation in 20 to 30 degree was the most common complication. 30% of patients complained of mild pain during walking. Conclusion: After appropriate treatment most patients with femoral neck fracture have no complications, however in some cases a vascular necrosis occurs as a serious complication. This study will provide clues and information to design studies with more patients to assess how different treatment methods have impact on outcomes of patients.