Surgical Treatment of Leg Length Discrepancy and Knee Flexion Contracture Associated with a Congenital Absence of Quadriceps

We report the case of an 18-year-old male with congenital absence of quadriceps and hypoplasia of the patella who presented with a significant leg length discrepancy (LLD) and knee flexion contracture. Surgical management was aimed toward lengthening the limb, stabilizing the joint, and correcting the knee flexion contracture. Correction of a significant congenital LLD and knee flexion contracture poses challenges due to long-standing altered biomechanics. These are rare conditions for which no accepted surgical algorithms exist. It is essential to anticipate the biomechanical consequences of limb lengthening and flexion contracture correction that might arise and plan comprehensive interventions accordingly.

Correction of Hand Deformities after Burn

Hand burns can lead to deformities even after successful primary healing. They are the most common cause of skin contractures involving the hand. This review article discusses ways to correct claw deformity, flexion contracture in palm and finger, and web space contracture, which are post-burn hand deformities commonly encountered in clinical practice. Loss of skin is the end result in many causes of hand deformities after burn. Therefore, reinforcing the lost skin is the principle of corrective surgery. Even if the skin is thicker than the full-thickness skin, it will engraft if damage to the tissue and blood vessels of the recipient is minimized. The thicker the skin, the less is the re-contraction and growth. The foot is an ideal donor site for skin graft on the hand. In particular, the instep or the area below the malleolar is a very good donor site. First web space of the hand is very important for hand function, and it must be reconstructed with Z-plasty, skin graft, and free flap step by step according to the degree of contraction.

Severity and location of lumbar spine stenosis affects the outcome of total knee arthroplasty

Background Recent studies have noted that patients with pre-existing lumbar spinal stenosis (LSS) have lower functional outcomes after total knee arthroplasty (TKA). Given that LSS manifests heterogeneously in location and severity, its influence on knee replacement merits a radiographically targeted analysis. We hypothesize that patients with more severe LSS will have diminished knee mobility before and after TKA. Methods This retrospective case series assessed all TKAs performed at our institution for primary osteoarthritis from 2017–2020. Preoperative lumbar magnetic resonance image (MRI) with no prior lumbar spine surgery was necessary for inclusion. Stenosis severity was demonstrated by (1) anterior–posterior (AP) diameter of the thecal sac and (2) morphological grade. TKA outcomes in 103 cases (94 patients) were assessed by measuring preoperative and postoperative arc of motion (AOM), postoperative flexion contracture, and need for manipulation under anesthesia. Results Patients with mild stenosis did significantly better in terms of postoperative knee AOM. As AP diameter decreased at levels L1–2, L2–3, L3–4, and L4–5, there was a significant reduction in preoperative-AOM (p < 0.001 for each), with a 16 degree decrease when using patients’ most stenotic level (p < 0.001). The same was noted with respect to increased morphological grade (p < 0.001), with a 5 degree decrease for patients’ most stenotic level (p < 0.001). Conclusion Severe LSS, which is readily demonstrated by a reduction in the AP diameter of the thecal sac or increased morphological grade on MRI, correlated with a significant reduction in preoperative AOM that was not improved after TKA. Persistent postoperative reductions in AOM may contribute to reduced patient satisfaction and recovery. Level of evidence: Level 4

Camptodactyly correction: A report of two cases

Camptodactyly is a condition where there is a permanent flexion contracture at the proximal interphalangeal joint mostly involving the little finger. This condition has a varied presentation and hence treatment is controversial, whether conservative management or surgical correction. Here, we present two cases of camptodactyly that were managed with surgery.

Study of soft tissue reconstruction in postburn flexion contracture of the hand

Background: Burn contracture of the hand can leave patients with severe functional and psychological limitations. This study evaluates the severity of the deformity and various reconstructive options in post-burn hand injuries.Methods: This work includes the study of 50 patients who underwent reconstruction for post-burn flexion contracture of the hand, including fingers, in the department of plastic surgery. The patients were treated between April 2007 to April 2009.Results: Males were more commonly affected by burn injuries and thermal burns were more common than electrical burns. The little finger showed higher involvement and contracture release followed by grafting was the commonly done reconstructive procedure.Conclusions: Split thickness skin graft (SSG) were more effective in reconstruction in thermal injuries, while cross finger flaps (CFF) showed more promise in electrical injuries of the hand.

Gender-specific difference in the recurrence of flexion contracture after total knee arthroplasty

Background Range of motion after total knee arthroplasty (TKA) can impact patients’ daily lives. Nevertheless, flexion contracture (FC) often recurs after TKA, even upon achieving full extension intraoperatively. This study aimed to evaluate the relationship among preoperative, intraoperative, and postoperative knee extension angles, and clarify the risk factor for postoperative FC. Methods One hundred forty-seven knees undergoing TKA using a navigation system were evaluated. We measured the pre- and postoperative (6 months after TKA) extension angles using a goniometer, and intraoperative (before and after TKA) extension angle using a navigation system; the correlation between these angles at each time point was evaluated. Results The mean preoperative, intraoperative (before and after TKA) and postoperative extension angles were -9.9°, -6.8°, -0.1°, and -2.0°. Regarding intraoperative extension angle after TKA, 58 knees showed ≤ 5° hyperextension and six knees showed > 5° hyperextension. At 6 months, no cases showed hyperextension and 105 knees showed full extension. The mean intraoperative extension angle after TKA in the postoperative full extension group was 0.4°. A significant correlation was found among extension angles at each point (p<0.01, respectively). However, the intraoperative extension angle after TKA correlated with the postoperative extension angle only in females. Contrarily, the recurrence rate of FC was significantly higher in males than in females (p<0.01). Conclusion Intraoperative extension angles significantly correlated with pre- and postoperative extension angles in TKA. Moreover, intraoperative mild (≤ 5°) hyperextension is acceptable for postoperative full extension. There was a gender-specific difference in correlation between intra- and postoperative knee extension angles. Level of evidence III.

Severity and Location of Lumbar Spine Stenosis Affects the Outcome of Total Knee Arthroplasty

BackgroundRecent studies have noted that patients with pre-existing lumbar spinal stenosis (LSS) have lower functional outcomes after total knee arthroplasty (TKA). Given that LSS manifests heterogeneously in location and severity, its influence on knee replacement merits a radiographically targeted analysis. We hypothesize that patients with more severe LSS will have diminished knee mobility following TKA. MethodsThis retrospective study assessed all TKAs performed at our institution for primary osteoarthritis from 2017-2020. Preoperative lumbar magnetic resonance image (MRI) with no prior lumbar spine surgery were necessary for inclusion. Stenosis severity was demonstrated by (1) anterior-posterior (AP) diameter of the dural sac and (2) morphological grade. TKA outcomes in 103 cases (94 patients) were assessed by measuring preoperative and postoperative arc of motion (AOM), postoperative flexion contracture, and need for manipulation under anesthesia. ResultsPatients with mild stenosis did significantly better in terms of postoperative knee AOM. As AP diameter decreased at levels L1-2, L2-3, L3-4, and L4-5, there was a significant reduction in preoperative-AOM (p<0.001 for each), with a 16 degree decrease when using patients’ most stenotic level (p<0.001). The same was noted with respect to increased morphological grade (p<0.001), with a 5 degree decrease for patients’ most stenotic level (p<0.001). ConclusionSevere LSS, which is readily demonstrated by a reduction in the AP diameter of the dural sac or increased morphological grade on MRI, correlated with a significant reduction in preoperative-AOM that was not improved after TKA. Persistent postoperative reductions in AOM may contribute to reduced patient satisfaction and recovery. Level of Evidence: Level 4

Post-traumatic digital flexion contracture (checkrein deformity)

Objective: The aim of this study is to present a series of 8 patients, describing their clinical picture and assessing their treatment using plantar approach. Methods: We retrospectively assessed 8 patients, all of which had a history of trauma. The clinical characteristics of these cases and postoperative results were investigated. Results: Seven men and 1 woman with a mean age of 29 years were included. The follow-up period ranged from 6 to 28 months (mean 22 months). The deformity manifested from 5 to 24 months after the triggering injuries (mean 9.8 months). The hallux was the only digit affected in 1 patient, while the others presented with involvement of 1 or more small toes. There were no postoperative complications, and patients showed to be satisfied with functional outcomes. Conclusion: Post-traumatic digital flexion contracture is an infrequent disease of unknown etiology. Lengthening of the flexor hallucis longus using a plantar approach, whether at the level of the midfoot or the toe, represents an alternative with satisfactory outcomes. Level of Evidence IV; Therapeutic Study; Case Series.