Degree Of Flexion Contracture Research Articles

Radial Head Arthroplasty with a Modular Metal Spacer to Treat Acute Traumatic Elbow Instability

The use of a metal radial head prosthesis to help stabilize an elbow with traumatic instability is appealing because internal fixation of multifragment, displaced fractures of the radial head is susceptible to either early or late failure. The newer modular prostheses are easier to size and implant, but their effectiveness has not been investigated, to our knowledge. Twenty-seven patients in whom a radial head replacement with a modular metal spacer prosthesis had been performed to treat traumatic elbow instability were evaluated with use of the Mayo Elbow Performance Index (MEPI), the American Shoulder and Elbow Surgeons Elbow Evaluation Instrument (ASES), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Radiographs were evaluated for arthrosis, periprosthetic radiolucency, and heterotopic ossification. Seven patients underwent one or more subsequent operations to treat residual instability, heterotopic ossification and elbow contracture, ulnar neuropathy, or a misplaced screw. In two of these patients, the prosthesis was removed as part of an elbow contracture release or to treat infection. At an average of forty months postoperatively, elbow motion in the entire group of twenty-seven patients averaged 131 degrees of flexion with a 20 degrees flexion contracture, 73 degrees of pronation, and 57 degrees of supination. Stability was restored to all twenty-seven elbows, and twenty-two patients had a good or excellent result according to the MEPI. Seventeen patients had radiographic evidence of lucency around the neck of the prosthesis that was not associated with increased pain, thirteen patients had clinically inconsequential heterotopic ossification anterior to the radial neck, and nine patients had radiographic changes in the capitellum. An intentionally loosely placed modular metal radial head prosthesis can help to restore stability in conjunction with repair of other fractures and reattachment of the lateral collateral ligament to the epicondyle in the setting of traumatic elbow instability with a comminuted fracture of the radial head. While a prosthesis that is too large can cause problems, lucencies around the stem of the intentionally loose prosthesis and most changes in the capitellum do not appear to cause problems, at least in the short term.

Total Knee Arthroplasty in Patients with Greater than 20 Degrees Flexion Contracture

Fixed flexion contracture can present a technical challenge in total knee arthroplasty. Various techniques of addressing these deformities have been described including additional bony resection, ligamentous releases, and the use of increasing constraint. We retrospectively reviewed the clinical outcomes of 40 patients (52 knees) with fixed flexion contracture greater than or equal to 20 degrees treated with revision TKA and a stepwise algorithmic approach to treating the contracture. A cruciate-retaining device was used in 31 knees, a posterior stabilized design was used in 14, a posterior stabilized constrained device was used in five knees, and a rotating hinged design in was used in two knees. Full correction was achieved intraoperatively. Ninety-four percent of knees had less than 10 degrees residual contracture at an average followup of 37 months. We revised one case of postoperative instability in the posterior stabilized group and we had one infection in the cruciate-retaining group. No other revisions were performed. The stepwise algorithmic approach to treating fixed flexion deformity presented in this study in primary total knee arthroplasty is safe and effective.

Bone resection and ligament treatment for flexion contracture in knee arthroplasty.

A retrospective study of 103 knees (88 patients) who had primary total knee arthroplasty with a flexion contracture ranging from 20 degrees to 60 degrees was done to tabulate the primary soft tissue structures released during surgery and to identify any residual deformity. The average flexion contracture preoperatively was 27.1 degrees +/- 8 degrees and postoperatively was 2.7 degrees +/- 3.4 degrees (range, 0 degrees -10 degrees ). The average followup was 70.4 months (range, 12-180 months). Only medial or lateral soft tissue balancing procedures were necessary to correct the flexion contracture in 37 knees (35.9%) and no medial or lateral release was necessary in 25 knees (24.3%), of which 16 had a balanced posterior cruciate ligament. The posterior capsule was released on the deformity side of the knee in 15 knees (14.6%) and on the opposite side of the deformity in seven knees (6.8%). The posterior cruciate ligament was balanced in 21 knees (20.4%) and was released in four knees (3.9%). For all knees in which the posterior cruciate ligament was released or balanced, it was done for excessive rollback and tightness in flexion and not for flexion contracture management. In two patients (2%) an additional 4 mm of distal femur was resected for a 45 degrees and a 25 degrees flexion contracture. The data suggest that a contracted collateral ligament is the most likely primary structure whose effective release allows correction of the flexion contracture in most cases.

Ilizarov Technique in Treatment of Congenital Hand Anomalies

An Ilizarov apparatus was successfully used in the treatment of a six-year-old child with a radially deviated hand caused by congenital pseudoarthrosis of the distal radius after previous traditional surgery failed. The limb length was restored, the pseudoarthrosis healed, and the deviated hand corrected. A second child, five years old, with Poland's syndrome, had a 90 degrees flexion contracture of the wrist that was treated with the Ilizarov apparatus. The flexion contracture was gradually corrected. It seems that the Ilizarov apparatus can be an important tool in the treatment of complex limb deformities.

Massive allograft replacement of hemiarticular traumatic defects of the elbow

Four elbow osteoarticular allografts were done for four patients as salvage procedures for unreconstructable elbow fracture malunions. With a mean follow-up of 60 months (range, 12 to 72 months) all elbows were stable, free of pain, and had mean motion of 130 degrees active flexion and 27 degrees of flexion deformity, 67 degrees pronation and 62 degrees supination (preoperative mean: 104 degrees flexion, 42 degrees flexion contracture, 20 degrees pronation, and 34 degrees supination). Complications occurred in two elbows. One had a deep infection necessitating graft removal and subsequent regrafting. The second had an olecranon osteotomy nonunion. Elbow allografting is recommended as a salvage procedure for massive posttraumatic articular defects, bone loss, or malunion when neither arthrodesis nor conventional arthroplasty is indicated.