Between January 2003 to 2013 Judet's Quadricepsplasty was performed on 32 stiff knees. The initial preoperative range of movement was 15° (range 10°-25°). Postoperative plaster immobilization was only for 1 day. The mean follow up period was 6 years (range 2-10 years). During our follow up the mean active flexion was 70° (range 60°-120°). Final outcome in knee movement was 90° (40°-175°). In our series six patients developed wound dehiscence which resolved after meticulous wound care and antibiotics. In our all the cases we believe that Judet's Quadricepsplasty gives excellent result with proper postoperative care and CPM therapy. The treatment of knee extension contracture must therefore vary from simple arthroscopy to lyse adhesions to more extensive quadricepsplasty. Quadricepsplasty can be divided into distal and proximal types. Distal quadricepsplasty, such as the Thompson or V-Y types, should never be performed in adults because it leads to permanent knee extension lag. This may occur in children as well, but because the children are growing and retensioning their quadriceps muscle, it may recover. The best way of obtaining knee flexion is the Judet's Quadricepsplasty [1,2]. This is a proximally based quadriceps muscle slide that addresses all the elements of the knee contracture. It was popularized by Letournel. The Judet's quadricepsplasty is a stepwise release of the knee and quadriceps muscle. Each successive step determines whether one continues with the next step of the release depending on the amount of knee motion recovered.In our series Judet's quadricepsplasty for stiff knee was done on 32 cases from January 2003 to January 2013 with proper postoperative management with CPM machine in an attempt to improve the knee range of motion. Materials and MethodsThis study was conducted in NITOR (National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka) and BARI-ILIZAROV Orthopaedic Centre between January 2003 to January 2013. The mean age of the patient was 26 years (20-35 years) and the total number of patients were 32. All patients were male. All the patients developed stiff knee after periarticular knee fractures or Ilizarov application.We retrospectively reviewed the results of 32 cases of knee extension contracture managed with Judet's quadricepsplasty during the last 10 years having a mean follow up of 24 months. Degrees of flexion of the operated knees preoperatively and at last follow up were recorded along with quadriceps strength, presence of extension lag and complications. Surgical techniqueThe incision is marked for the full length of the thigh from the rough line of the greater trochanter to the lateral aspect of the patellar tendon. During surgical intervention we must give imphasize with these following 5 steps [1,3]:Step-1 (Intra articular release): Under tourniquet, only the distal part of the incision is made to release the knee adhesions from the lateral side.
The management of the humerus nonunion is one of the most challenging problems that the surgeon confronts in his practice. The procedures traditionally used are: I.M. Nailing, interlocking, plating, transplantation of allograft. In our series, 56 cases with nonunion has been treated by G.A. Ilizarov technique. The age range was: 21-62 years with an average of 32 years. The initial treatment was done by DCP, rush nails & plates with screw fixation. The duration of treatment ranged from 5-11 months (average 8 months). With the Ilizarov fixator application a good range of elbow & shoulder motion were achieved. The average follow up period was 15 years with a range of 1-22 years. Union was achieved in all the 56 cases.
Cubitus valgus is the most common complication of lateral condylar fractures. Various combinations of osteotomy and fixation have been described to correct valgus deformity. We are using distraction osteogenesis with Ilizarov technique to treat 11 elbows in 11 patients with cubitus valgus. The clinical outcome was evaluated using the protocal of Bellemore et al. [1]. The mean time to follow up was 20 months (15 to 35) and the mean time to Ilizarov frame removal was 14 weeks (10 to 18). The mean carrying angle was corrected from 35˚ (25˚ to 40˚) to 10.4˚ (5˚ to 15˚) in patients with cubitus valgus. There were 8 excellent and 3 good results.
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