Major Joint Contractures in Children

Joint contractures, defi ned as a chronic loss of joint movement secondary to changes in the non-osseous structures of the joint, are common in all branches of Orthopaedics and, indeed, the principles of management of such contractures form part of the basic workload of all Orthopaedic surgeons. Although many people may think of contractures in terms of a tight or short muscle-tendon unit there are other soft tissues that can be implicated such as the skin and subcutaneous tissues, the ligaments and the joint capsule itself. Often there is a combination of problems either due to the aetiology of the condition or due to its long-standing nature. Changes in bone shape are also common and may infl uence prognosis and management.

In children, joint contractures pose a particular problem. On the one hand children are often able to cope with a sig-nifi cant degree of contracture and develop and maintain a functional level surprisingly well but on the other hand the process of growth often acts against them making contrac-tures more problematic with time.