Slow, Gradual External Fixation Distraction for Treatment of Postburn Knee Flexion Contracture

Barquet, Antonio; Suero, Carlos; Cortés, Orlando; López, Luis

doi:10.1097/00006534-199304001-00036

Cited by 12 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As previously reported, there are applications for the external fixator without resorting to skin grafting to treat burned stiff joints. Barquet et al specially designed an external fixator to gradually and slowly draw the flexion contracture of patients with knee stiffness, which resulted in satisfying effects [21]. Saghieh et al applied Ilizarov external fixation to solve skin ductility difficulty in three cases of burned ankle stiffness patients [22].…”

Section: Discussionmentioning

confidence: 99%

Treatment and Rehabilitation of Knee Joints Straight Stiffness After Burns

Tang

et al. 2014

Indian J Surg

View full text Add to dashboard Cite

The knee release surgery and postoperative rehabilitation of patients after burns and knee straight stiffness were investigated. Eleven patients were treated for 16 side burns and knee stiffness who consisted of nine males and two females, aged 19 to 54 years (mean=33.2). The duration of the patients' knee stiffness ranged from 8 to 26 months, with an average of 12.6 months. Their preoperative flexion ranged from 5°to 50°, with an average of 26.2°. Their preoperative Hospital for Special Surgery (HSS) knee scores ranged from 46 to 72 points, with an average of 55.8 points. All stiff knees were treated with release surgery, along with total release of intra-articular adhesion and excision of vastus intermedius. After the arthrolysis of the stiff knee joint, the tight skin was completely loose in the adhesions. The soft tissue contracture was not grafted, but the shade fascia was freed to increase skin ductility. All knee joints were released to more than 90°of flexion in the operation, and reversed fascia flaps were used to suture the loss of the deep fascia at the position of flexion of 90°. After the operation, the knee joint was fixed in flexion for 72 h while being actively cared for by early rehabilitation. Subsequently, the patient's skin coverage, joint motion, and joint function recovery were observed. Based on the followup of the patients for the following 16 to 36 months (mean= 25.7), the knee flexion of the patients ranged from 110°to 135°, with an average of 122.2°and 96°increase (P<0.01). Furthermore, the patients had better skin ductility to meet the increase in joint flexion. HSS knee function scores at the end of follow-up ranged from 93 to 100 points, with an average of 97.5 points and an increase of 41.7 points (P<0.01). The joint function improved significantly. The arthrolysis of straight stiff knee joints after burns can ease muscle contracture and free the shade fascia, thus avoiding the need to undergo skin grafting. Short-term fixation of the joints after surgery and active flexion rehabilitation may also be the key to improve skin ductility and joint function of the patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Treatment and Rehabilitation of Knee Joints Straight Stiffness After Burns

Tang

et al. 2014

Indian J Surg

View full text Add to dashboard Cite

show abstract

“…The so-called ‘heat and stretch’ technique combining physical modality (heat) and mechanical stress (Warren et al 1976) is a widely used therapeutic method. The treatment programme for joint contracture consists of positioning, ROM exercise by a therapist and functional splinting, which include exoskeletal fixation, static progressive splinting (Barquet et al 1993, Bonutti et al 1994, Schultz-Johnson 2002) and other devices (Kasabian et al 1998, Charlton et al 1999, Gelinas et al 2000). External fixation systems, such as the Ilizarov method, have been used for joint contracture as well as leg lengthening (Damsin and Ghanem 1995, Huang 1996, van Roermund et al 1998).…”

Section: Discussionmentioning

confidence: 99%

A computer-controlled contracture correction device with low-load and continuous torque

Akai¹,

Usuba

Sekiguchi

et al. 2007

Prosthetics &Amp; Orthotics International

View full text Add to dashboard Cite

The purpose of this study was to clarify the relationship between mechanical stress and tissue response of the contracted knee joint in rats and to propose a new design of contracture correction device for clinical use. Wistar rats were operated on to immobilize their knee joints with a procedure causing periarticular bleeding and were kept in flexed position for 40 days. At day 40, the immobilizing wire was removed, and after day 43, the contracted knee joint had been treated with tunable corrective devices secured by an external fixation method to the rear limb. These devices consisted of four types of motor-driving system which provided several different low-load and continuous stretch torques. Measuring the angle of maximum knee extension, its effectiveness was assessed comparing with a lower load and control group of natural recovery course. The device also had a cyclic joint movement within the acquired range of motion and an oval cam mechanism producing a small distraction force to the joint along its long axis. The results showed that an appropriate range of low-load continuous torque was more effective to correct joint contracture. On the basis of the animal experiment, a new computer-controlled, gas-driven contracture correction device was developed for clinical trial. It was concluded that mechanical application in a condition with low and continuous torque is a useful treatment for fixed joint contracture.

show abstract

“…Non-surgical methods include physical therapy, 1,3-5 corrective orthotic devices, [6][7][8][9][10] serial casting [11][12][13] and orthopaedic non-surgical reduction followed by casting under general anaesthesia. 2 Surgical methods like external fixators, [14][15][16][17][18] soft tissue release, [19][20][21] osteotomy 22,23 and arthroplasty, 24 have also been considered among treatment options for KFD associated with limitations in daily functioning.…”

Section: Introductionmentioning

confidence: 99%

“…Based on the severity of KFD, patients were grouped into three categories; I, KFD ≤ 30 degrees; II, 31-60 degrees and III, >60 degrees. For analysis, functional correction (FC) was defined as correction to a residual KFD of [11][12][13][14][15][16][17][18][19][20] degrees and optimal correction (OC), was defined as correction to ≤10…”

Section: Introductionmentioning

confidence: 99%

Non‐surgical correction of knee flexion deformity in persons with haemophilia: A staged multidisciplinary approach

Tilak,

John,

Paul

et al. 2024

Haemophilia

View full text Add to dashboard Cite

IntroductionFlexion deformity of the knee is a common complication following recurrent haemarthrosis in persons with haemophilia (PWH) on episodic factor replacement therapy, restricting independent mobility. There is limited literature on the comprehensive management of this condition. This report provides the outcome of a staged multidisciplinary approach for the correction of knee flexion deformity (KFD) even in limited resource settings.Patients and methodsThe data of 49 consecutive PWH who were treated for KFD were analysed. The approach included graded physical therapy (PT), followed by serial casting and/or mobilisation under anaesthesia (MUA). MUA was done in carefully selected knees. Surgical correction was opted when non‐surgical methods failed.ResultsOf the 49 patients (55 knees), with a median KFD of 40 degrees (range: 10–90), 26/55 (47%) were corrected by graded PT. With serial casting, 9/19 (47%) knees had their KFD corrected. MUA was done for 11 knees of which five achieved correction (45%). Surgical correction was required for only seven knees (12.7%). Following this approach, KFD improved from 40 degrees (range: 10–90) to 15 degrees (range: 0–40), with only minor loss of flexion from 105 (range: 60–155) to 90 degrees (range: 30–150). Out of 55 KFD, 46 (83.6%) KFD were corrected; non‐surgical, 39 (70.9%) and surgery, seven (12.7%). The remaining patients (nine KFD; 16.4%) were able to achieve their functional goal despite not meeting the correction criteria.ConclusionThis study shows that in PWH, functionally significant KFD correction can be achieved in about 71%, through non‐surgical methods, even without prophylactic factor replacement.

show abstract

Slow, Gradual External Fixation Distraction for Treatment of Postburn Knee Flexion Contracture

Cited by 12 publications

References 0 publications

Treatment and Rehabilitation of Knee Joints Straight Stiffness After Burns

Treatment and Rehabilitation of Knee Joints Straight Stiffness After Burns

A computer-controlled contracture correction device with low-load and continuous torque

Non‐surgical correction of knee flexion deformity in persons with haemophilia: A staged multidisciplinary approach

Contact Info

Product

Resources

About