Quadricepsplasty following femoral shaft fractures

Ikpeme, J.O.

doi:10.1016/0020-1383(93)90199-g

Cited by 25 publications

(28 citation statements)

References 8 publications

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“…In this study the skin sutures were retained upto 3 to 4 weeks time postoperatively [6][7][8]. The postoperative care after quadricepsplasty is very important if the flexion is to be maintained without loss of active extension [6,9].…”

Section: Discussionmentioning

confidence: 99%

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Judet's Quadricepsplasty for Extension Contracture of the Knee (Stiff Knee)

Bari¹

2015

MOJOR

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Between January 2003 to 2013 Judet's Quadricepsplasty was performed on 32 stiff knees. The initial preoperative range of movement was 15° (range 10°-25°). Postoperative plaster immobilization was only for 1 day. The mean follow up period was 6 years (range 2-10 years). During our follow up the mean active flexion was 70° (range 60°-120°). Final outcome in knee movement was 90° (40°-175°). In our series six patients developed wound dehiscence which resolved after meticulous wound care and antibiotics. In our all the cases we believe that Judet's Quadricepsplasty gives excellent result with proper postoperative care and CPM therapy. The treatment of knee extension contracture must therefore vary from simple arthroscopy to lyse adhesions to more extensive quadricepsplasty. Quadricepsplasty can be divided into distal and proximal types. Distal quadricepsplasty, such as the Thompson or V-Y types, should never be performed in adults because it leads to permanent knee extension lag. This may occur in children as well, but because the children are growing and retensioning their quadriceps muscle, it may recover. The best way of obtaining knee flexion is the Judet's Quadricepsplasty [1,2]. This is a proximally based quadriceps muscle slide that addresses all the elements of the knee contracture. It was popularized by Letournel. The Judet's quadricepsplasty is a stepwise release of the knee and quadriceps muscle. Each successive step determines whether one continues with the next step of the release depending on the amount of knee motion recovered.In our series Judet's quadricepsplasty for stiff knee was done on 32 cases from January 2003 to January 2013 with proper postoperative management with CPM machine in an attempt to improve the knee range of motion. Materials and MethodsThis study was conducted in NITOR (National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka) and BARI-ILIZAROV Orthopaedic Centre between January 2003 to January 2013. The mean age of the patient was 26 years (20-35 years) and the total number of patients were 32. All patients were male. All the patients developed stiff knee after periarticular knee fractures or Ilizarov application.We retrospectively reviewed the results of 32 cases of knee extension contracture managed with Judet's quadricepsplasty during the last 10 years having a mean follow up of 24 months. Degrees of flexion of the operated knees preoperatively and at last follow up were recorded along with quadriceps strength, presence of extension lag and complications. Surgical techniqueThe incision is marked for the full length of the thigh from the rough line of the greater trochanter to the lateral aspect of the patellar tendon. During surgical intervention we must give imphasize with these following 5 steps [1,3]:Step-1 (Intra articular release): Under tourniquet, only the distal part of the incision is made to release the knee adhesions from the lateral side.

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Section: Discussionmentioning

confidence: 99%

“…The postoperative care after quadricepsplasty is very important if the flexion is to be maintained without loss of active extension [6,9]. Exercises with CPM machine and strengthening exercises of the quadriceps must be performed intensively for 6 weeks after the surgery [10,11].…”

Section: Discussionmentioning

confidence: 99%

Judet's Quadricepsplasty for Extension Contracture of the Knee (Stiff Knee)

Bari¹

2015

MOJOR

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“…The overall outcome was better than the results previously reported which ranged from 9.5% to 100%. 1,[4][5][6]9 With the Thompson technique, vastus medialis, vastus lateralis and vastus intermedius are freed from rectus femoris through an anterior midline incision. 6,12 Rectus femoris is then isolated from the rest of the quadriceps mechanism.…”

Section: Discussionmentioning

confidence: 99%

“…The extension lag after quadricepsplasty varies from 8° to 52°. 1,[4][5][6]9,11 Moore et al 10 reviewed nine patients: six developed a mean lag of 10°. Nicoll 11 described 30 patients, seven of whom had a persistent lag of between 5° and 45°, and postoperative rehabilitation was abandoned.…”

Section: Discussionmentioning

confidence: 99%

“…This is especially so with associated gross soft-tissue injuries, multiple fractures, comminuted fractures and if rehabilitation is delayed. 1,2 Several methods of quadricepsplasty have been described such as the Thompson and Judet techniques and their modifications. [3][4][5][6][7][8][9][10][11][12][13][14] Thompson's quadricepsplasty may be complicated by skin necrosis and loss of full extension.…”

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A modified Thompson quadricepsplasty for the stiff knee

Hahn

Lee

Han

2000

The Journal of Bone and Joint Surgery. British volume

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Patients and MethodsBetween March 1987 and March 1997, 20 modified Thompson quadricepsplasties were performed by one of the authors (SBH). The mean age of the patients was 37 years (18 to 64). There were 18 men and two women. In 17, the procedure followed a fracture of the femur. Of the remaining three, two had achondroplasia and stiffness resulting from femoral lengthening by the Ilizarov method, and one had suffered poliomyelitis. The mean interval between the initial operation and quadricepsplasty was 28 months (14 to 60). The mean flexion contracture was 7.0° (0 to 30) with active flexion to 50.0° (5 to 80). The mean range of movement was thus 43.0° (5 to 80). The mean follow-up was 35 months (24 to 52). The range of movement of the knee was measured at each visit by the surgeon who had performed the operation (SBH) using a goniometer with 30 cm movable arms and a scale marked in 1° increments. The stationary arm of the goniometer was placed parallel to the long axis of the femur along a line extending from the greater trochanter to the lateral condyle, and the movable arm was placed parallel to the long axis of the fibula, between the head of the fibula and the lateral malleolus.The final results were assessed by Judet's criteria: 8 excellent, if flexion was greater than 100°; good, from 81° to 100°; fair, from 50° to 80°; and poor, if less than 50°. Operative technique. Medial and lateral parapatellar incisions were used for arthrolysis (Fig. 1a). The knee was then flexed and if inadequate flexion was obtained, an anterolateral or lateral incision in the distal two-thirds of the thigh was performed to release adhesions around the quadriceps muscle (Fig. 1a). The tensor fascia lata was divided transversely in the distal thigh. Vastus lateralis was isolated from rectus femoris and released close to its patellar insertion (Fig. 1b). Vastus medialis was released from rectus femoris by stripping with a finger (Fig. 1b). Rectus femoris was freed from vastus intermedius and from the anterior surface of the femur and upper pole of the patella (Fig. 2a). In four cases in which a satisfactory range of flexion had not been achieved at this stage, Z-plasty of rectus femoris was performed to lengthen the tendon (Fig. 2b). The procedures were carried out using a tourniquet, and the wound was closed over suction drainage. The tourniquet was released, and the appearance of the skin flap was checked, while the

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