Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2007 Dec;2(2-3):91-7.
doi: 10.1007/s11751-007-0026-4. Epub 2007 Dec 4.

Monolateral external fixation for the progressive correction of neurological spastic knee flexion contracture in children

Pedro Gutiérrez Carbonell  1 , Jose Valiente Valero, Pedro Doménech Fernández, Javier Roca Vicente-Franqueira
Affiliations

Monolateral external fixation for the progressive correction of neurological spastic knee flexion contracture in children

Pedro Gutiérrez Carbonell et al. Strategies Trauma Limb Reconstr. 2007 Dec.

Abstract

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.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
a LRS-monolateral external fixator system rails; b special clamp that blocks the compressor–distractor devices; c, d lateral and superior view of special clamps threading inside rail system
Fig. 2
Fig. 2
a, b Lateral and superior view of rotation hinge; c compressor–distractor devices (short and large)
Fig. 3
Fig. 3
Provisional placement of the guided K-pin, that allows the setting of the hinge in the knee’s rotation center
Fig. 4
Fig. 4
a, b “In Vitro” and c “In Vivo” mobility of the hinge, when elongation–distraction is applied to the compressor–distractor device
See this image and copyright information in PMC

References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/S0140-6736(89)91848-5', 'is_inner': False, 'url': 'https://doi.org/10.1016/s0140-6736(89)91848-5'}, {'type': 'PubMed', 'value': '2573757', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/2573757/'}]}
    2. Grant A, Joy M-T, O´Brien N, Hennessy E, MacDonald D (1989) Cerebral palsy among children born during the Dublin randomised trial of intrapartum monitoring. Lancet 25:1233–1235 - PubMed
    1. None
    2. Herring JA (2002) Disorders of the brain. In: Herring JA (eds) Tachdjian’s pediatric orthopaedics from the Texas Scottish Rite Hospital for children. WB Saunders, Philadelphia, pp 1121–1242
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PMC', 'value': 'PMC1882364', 'is_inner': False, 'url': 'https://pmc.ncbi.nlm.nih.gov/articles/PMC1882364/'}, {'type': 'PubMed', 'value': '1633518', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/1633518/'}]}
    2. Stanley FJ, Watson L (1992) Trends in perinatal mortality and cerebral palsy in Western Australia, 1967 to 1985. BMJ 304:1658–1663 - PMC - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1097/00004694-199905000-00016', 'is_inner': False, 'url': 'https://doi.org/10.1097/00004694-199905000-00016'}, {'type': 'PubMed', 'value': '10344322', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/10344322/'}]}
    2. Abel MF, Damiano DL, Pannunzio M, Bush J (1999) Muscle-tendon surgery in diplegic cerebral palsy: functional and mechanical changes. J Pediatr Orthop 19:366–375 - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/S0140-6736(82)91759-7', 'is_inner': False, 'url': 'https://doi.org/10.1016/s0140-6736(82)91759-7'}, {'type': 'PubMed', 'value': '6121191', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/6121191/'}]}
    2. Alberman E, Benson J, McDonald A (1982) Cerebral palsy and severe educational subnormality in low-birthweight children: a comparison of births in 1951–53 and 1970–73. Lancet 1(8272):606–608 - PubMed

LinkOut - more resources