Summary
Contractures of the knee after poliomyelitis are common in children in developing countries and treatment, particularly that of severe contractures, presents a surgical challenge. This paper describes a new method for correcting contractures of the knee. Mild contractures need manipulation only and a plaster cast. Moderate contractures are treated by a partial soft-tissue release of the hamstrings and fascia lata followed by gradual stretching of the remaining soft-tissues by manipulation and plaster. Where the contracture is severe, skeletal traction is used through Steinmans pins inserted into the tibia and os calcis. One hundred and thirty-six knees with varying degrees of contracture were treated by these methods. Full correction was achieved and then maintained by plaster immobilisation, physiotherapy and calipers. This prevented recurrence during an average follow-up period of two and a half years. The severity of the contracture of the knee was in direct proportion to the severity of associated flexion-abduction contractures at the hip and equinus deformity at the ankle, the degree of muscle imbalance. All of the contractures of the hip and some of the ankle (46.8%) needed simultaneous operative correction. The basic method is technically simple, requires no special equipment and the results recommend its use particularly in developing countries.
Résumé
Les rétractions du genou après poliomyélite sont fréquentes chez les enfants des pays en voie de développement. Leur traitement reste un défi chirurgical, notamment en ce qui concerne les rétractions aigües. Cet article décrit une nouvelle méthode de correction des rétractions des genoux: un allongement partiel des parties molles (ischiojambiers et fascia lata) suivi d'une extension progressive du reste des parties molles soit par manipulations, soit par plâtre (dans les rétractions modérées) ou par double traction squelettique transtibiale et transcalcanéenne (dans les rétractions sévères). Les rétractions bénignes du genou, toutefois, ne requièrent que manipulations et plâtre. 136 rétractions du genou ont été traitées selon cette méthode. Après correction complète, l'immobilisation par plâtre, la physiothérapie et l'appareillage ont empêché la récidive des déformations avec un recul de deux ans et demi. La sévérité des rétractions du genou était directement proportionnelle à celles de la hanche (flexion — abduction) et de la tibio-tarsienne (équinisme) et avec le déséquilibre musculaire. Toutes les hanches et certaines tibio-tarsiennes (46,8%) ont eu besoin d'une correction opératoire simultanée. Cette méthode est techniquement simple et ne nécessite pas d'≡uipement spécial. Ses résultats permettent de recommander son utilisation dans les pays en voie de développement.
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A preliminary report on part of the study, ‘The treatment of severe post-polio knee contractures’, was read at the 31st Annual Conference of the Association of Surgeons of East Africa, Mombasa, Kenya, in December, 1980
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Parekh, P.K. Flexion contractures of the knee following poliomyelitis. International Orthopaedics 7, 165–172 (1983). https://doi.org/10.1007/BF00269501
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DOI: https://doi.org/10.1007/BF00269501