A case report of successful treatment of 90° knee flexion contracture in a patient with adult-onset Still’s disease

He, Qiang; Xiao, Lin; Ma, Jianbing; Zhao, Guanghui

doi:10.1186/s12893-016-0122-9

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…Additional distal femur resection and Z-plasty procedure over iliotibial tract and biceps tendon after knee arthroplasty may be needed in severe cases. Performing a Z-plasty procedure before knee arthroplasty is associated with a high rate of tibial dislocation [ 63 ]. Postsurgery serial casting or other orthotic management by gradual and controlled knee extension with regular continuous passive stretching resulted in increased range of movement.…”

Section: Discussionmentioning

confidence: 99%

A holistic approach for severe flexion contracture of bilateral hip, knee, and ankle joints in a neglected patient with prolonged knee–chest positioning on extreme undernourishment: a case report and review of the literature

2022

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Background Flexion contracture in the lower extremity is a common finding in the patient with neuromusculoskeletal disorders. However, severe cases due to prolonged immobilization in knee–chest position are rarely established and remain underreported. This condition is associated with high morbidity and reduced quality of life, especially when it comes to neglected cases with missed injury and late presentation for adequate primary care and rehabilitative program. It remains a difficult challenge to treat, with no established treatment protocol. In addition, other factors related to psychological and socioeconomic conditions may interfere and aggravate the health state of such patients. Case presentation A 19-year-old Javanese man presented with flexion contracture of bilateral hip, knee, and ankle joints due to prolonged immobilization in knee–chest position for almost 2 years following a traffic accident and falling in the bathroom. The condition had persisted for the last 3 years due to irrecoverable condition and lack of awareness. In addition, the patient also presented with paraplegia at level L2–S1, dermatitis neglecta, multiple pressure ulcers, community-acquired pneumonia, and severe malnutrition. Prolonged and sustained passive stretching with serial plastering were performed in the patient. By the time of discharge, patient was able to move and ambulate using wheelchair. Progressive improvement of range of motion and good sitting balance were observed by 3-month follow-up. Conclusion A combination of surgery and rehabilitative care is required in the setting of severe flexion contracture. Passive prolonged stretching showed a better outcome and efficacy in the management of flexion contracture, whether the patient undergoes surgery or not. However, evaluation of residual muscle strength, changes in bone density and characteristic, and the patient’s general and comorbid conditions must always be considered when determining the best treatment of choice for each patient to achieve good outcome and result. A holistic approach with comprehensive assessment is important when treating such patients.

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Section: Discussionmentioning

confidence: 99%

A holistic approach for severe flexion contracture of bilateral hip, knee, and ankle joints in a neglected patient with prolonged knee–chest positioning on extreme undernourishment: a case report and review of the literature

2022

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Role of Ilizarov external fixator in the treatment of long-standing knee flexion deformity in adults: A prospective cohort study

Meselhy

Elhammady

2020

Current Orthopaedic Practice

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Background: One of the major disabilities of the lower limb is fixed knee flexion deformity. Post-polio residual paralysis is the main etiology, but there are others. This study evaluated the outcome of treatment of long-standing fixed knee flexion deformity with the Ilizarov external fixator without soft-tissue intervention or osteotomy in a certain age group. Methods: Thirty patients (33 knees) with knee flexion deformity were enrolled in this study. There were 11 women and 19 men. Three patients had bilateral lower limb affection. The etiology was post-polio residual paralysis in 11 patients (14 knees), four patients had brain insult, eight patients had post infectious etiology, and seven patients had failure of open reduction and internal fixation of tibial plateau fractures. An Ilizarov fixator was applied in all patients for deformity correction with no soft-tissue release or osteotomies. Results: The mean age of the patients was 28.7 yr (18-55 yr), the mean preoperative flexion knee angle was 77.87 degrees (50-130 degrees). The mean preoperative arc of motion was 17.1 degrees (0-50 degrees), the mean time since the deformity was well established was 9.4 yr (4-30 yr), the mean time needed for correction of the deformity was 49.2 days (27-120 days) at the end of the procedure. All patients achieved full correction of the deformity. Conclusions: The Ilizarov external fixator is an effective tool in the treatment of severe long-standing fixed knee flexion deformity in adults with minimal complications and good outcomes. Level of Evidence: Level II.

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Functional ambulation with bent knee prostheses for an adult with bilateral 90 degrees knee flexion contractures—A case report

Shandilya¹,

Parmar²,

Shandilya

2020

J Family Med Prim Care

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An adult male who never stood, ambulating on all four due to bilateral severe knee flexion contractures, since his childhood, was 21 years of age, and not deterred by his condition, was pursuing his higher education. He was coaxed by his friends to seek medical opinion and it was decided to give a trial and let the client have a feel of bipedal stance and ambulation. Although there is a paucity of recent evidence on the use of bent knee prosthesis, the trial successfully restored the dignity.

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A case report of successful treatment of 90° knee flexion contracture in a patient with adult-onset Still’s disease

Cited by 3 publications

References 15 publications

A holistic approach for severe flexion contracture of bilateral hip, knee, and ankle joints in a neglected patient with prolonged knee–chest positioning on extreme undernourishment: a case report and review of the literature

A holistic approach for severe flexion contracture of bilateral hip, knee, and ankle joints in a neglected patient with prolonged knee–chest positioning on extreme undernourishment: a case report and review of the literature

Role of Ilizarov external fixator in the treatment of long-standing knee flexion deformity in adults: A prospective cohort study

Functional ambulation with bent knee prostheses for an adult with bilateral 90 degrees knee flexion contractures—A case report

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