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Supracondylar Femoral Frx: Post Op Care

- 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. Juedet R, Judet J, Lagrange J. Mem Acad Chir. 1956;82:944-947.

The results of quadricepsplasty on knee motion following femoral fractures.

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.

Quadriceplasty: the Judet technique and results in six cases.

Quadricepsplasty to improve knee function.