- See:
- Discussion:
- consider 90 deg of flexion in splint for 4 days, then begin CPM;
- need to start early motion;
- look for late varus collapse of knee;
- attempt to ambulate at 2-4 days, & consider FWB at 3-6 months;
- delayed union: persistent instability 3-4 mo after injury;
- more bone grafting may be necessary to salvage inadequate union;
- Accetable Alignment:
- saggital alignment of less than 5 deg antecurvatum or less than 10 deg of
retrocurvatum is acceptable;
- frontal plane and rotational alignment of less than 5 deg is acceptable;
- Extension Contractures:
- more common w/ non surgical treatment;
- results from:
- intra articular adhesions;
- parapatellar adhesions;
- obliteration of the lateral gutters;
- obliteration of the suprapatellar pouch;
- fibrosis of vastus intermedius that ties down rectus femoris to the
anterior aspect of femur;
- shortening of lateral and medial quad expansions;
- shortening of rectus femoris;
-
treatment:
- quadricepsplasty, will release in sequence all pathologic adehesions and will
provide most pts with age ROM of 5-90 degs;
- incision is made from a hands breadth below the trochanter to the knee joint,
over the lateral side of the femur;
-
intrinsic release:
- lateral capsulotomy;
- removal of adehesions from the lateral gutters, supra-patellar pouch,
and undersurface of the patella;
-
extrinsic release:
- release of vastus lateralis from the linea aspera;
- elevation of the vastus intermedius from the anterior femoral surface;
-
post op: 3-4 months of rehab is required before maximum flexion is reached;
A technique for freeing the extensor apparatus in cases of stiffness of the knee.
R. Juedet, J. Judet, J. Lagrange.
Mem. Acad. Chir. 82: 944-947, 1956.
The restuls of quadricepsplasty on knee motion following femoral fractures.
TJ Moore, C. Harwin, SA Green, DE Garland, RW Chandler.
J. Trauma. 14: 402-406, 1987.
The Judet quadricepsplasty for management of severe posttraumatic
extension contracture of the knee. A report of a bilateral case and review of the literature.
Results of Judet Quadricepsplasty.
N.A. Ebralheim, R.J. DeTroye, and S.R. Saddemi.
J. Orthop. Trauma. Vol 7. No. 4. 1993. p 327.
Quadriceplasty: the Judet technique and results in six cases.
H. Daoud, T. O'Farrell, RL Creuss.
JBJS Vol 64-B. 1982. 194-197.
Quadricepsplasty to improve knee function.
TC Thompson.
JBJS Vol 26-A. 1944. p 366-379.
