Quadricepsplasty after War Fractures

Jovanović, Savo; Orlić, Dubravko; Wertheimer, Borna; Zelić, Zoran; Has, Borislav

doi:10.1093/milmed/165.4.263

Cited by 13 publications

(7 citation statements)

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“…Early systemic, holistic active and passive exercises are essential for recovery. Exercises with CPM must be performed as soon as possible after operation 4, 24 . Therefore, we routinely injected “cocktail” (ropivacaine 100 mg and betamethasone sodium phosphate 5 mg) into the local during the operation and used analgesics after the surgery.…”

Section: Discussionmentioning

confidence: 99%

Effects of Judet Quadricepsplasty in the Treatment of Post‐traumatic Extension Contracture of the Knee

Luo

Mei

et al. 2021

Orthopaedic Surgery

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Objective: To investigate the clinical outcomes and the affecting factors of Judet's quadricepsplasty on the stiffness of post-traumatic knee flexion.Methods: A retrospective survey was analyzed from June 2015 to October 2018. A total of 15 patients (eight males, seven females; mean age, 48.27 years) with extension contracture of the knee were treated by Judet's quadricepsplasty. All cases were injuries induced by fracture trauma. The mean interval between the initial procedure and quadricepsplasty was 56.2 months (range, 13-276 months). The knee range of motion (ROM) was assessed with a goniometer. The results of the procedure were analyzed by measuring the degrees of flexion of the operated knees at different time points (before, immediately after, and late postoperatively). We evaluated Hospital for Special Surgery (HSS) score, Judet's criteria, change in the degree of knee flexion, and complications.Results: All patients were followed up for 14 to 47 months, with an average of 31.53 months. The degree of flexion increased from 23.33 (range, 10 -50 ) preoperatively to 107.33 (range, 100 -125 ) intraoperatively, followed by a slight fall in the range of flexion in the late postoperative period, which reached an average of 95.33 (range, 60 -115 ) in the last follow-up. The knee joint function was assessed according to the Judet's criteria, eight cases (53.33%) achieved excellent results, six (40%) good, one (6.67%) fair, and zero (0.00%) poor results at final follow-up. The long-term excellent and good rate was 93.33%. The range of flexion of the knee during operation and at the last time of follow-up was better than that before surgery (P < 0.001). The final flexion was significantly lower than that measured at immediate postoperative (P < 0.001). The mean postoperative HSS score for the entire group was 93.73 (range, 89-96). Fifteen excellent results were obtained according to the HSS knee score. Skin infection was seen in one patient (6.67%). There were no complications such as deep sepsis, intraoperative rupture of the quadriceps tendon, fracture of the lateral femoral condyle, skin dehiscence. Conclusion:Judet quadricepsplasty is an effective method to treat knee extension contracture and improve knee range of motion (ROM). It should be performed by an experienced orthopaedic surgeon and followed by physiotherapy with continuous passive motion (CPM). The knee ROM obtained with the surgery has an excellent long-term effect.

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Section: Discussionmentioning

confidence: 99%

Effects of Judet Quadricepsplasty in the Treatment of Post‐traumatic Extension Contracture of the Knee

Luo

Mei

et al. 2021

Orthopaedic Surgery

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“…If the rectus femoris remains tight limiting flexion, lengthening of the rectus femoris is done, which in turn might cause considerable weakening of the extensor mechanism and an extensor lag [7,17] . Extensor lag has been widely reported using the Thompson technique [8,9,11,16,17,18,21] . Pick 18 reported two of three patients with an extensor lag, Moore et al [16] had six of nine, and Ratliff 19 had three of four.…”

Section: Discussionmentioning

confidence: 99%

Functional results of judet’s quadricepsplasty in the management of fixed flexion deformity of knee

Manimaran¹,

Muthu²

2019

Int. J. Orthop. Sci.

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Introduction: Prevalence of Fixed flexion deformity (FFD) of the Knee is more prevalent in Indian scenario due to prolonged immobilisation following indigenous method of treatment of fractures around knee. Quadricepsplasty has been described by Thompson and Judet to improve flexion in severely deformed knees. Judet's technique has potential advantages because it is less damaging to the quadriceps mechanism and addresses the problem of external fixator pin site tethering on the lateral side of the thigh. Methodology: This is a prospective study conducted in Omanthurar Multispecialty Hospital from 2013-2018. Patients presenting with FFD of any reason due to post op immobilisation or conservative management of the fractures around the knee are included in the study while patients with previous history of surgery to improve flexion deformity were excluded. All the patients were evaluated clinically to measure the available range of movement preoperative and Judets Quadricepsplasty was carried out in a standard fashion and intraoperative flexion range achieved is recorded and their function results at final follow-up is categorised based on Judet's criteria. Results: We included 32 patients into the study and the M: F ratio 1.42:1 with male preponderance. Etiology of the FFD being 18 patients due to indigenous management fractures around knee while 9 were due to external fixator for compound injuries and 5 due to post op immobilisation. Mean preoperative flexion was 33 o while intraop immediate mean flexion achieved was 112 o and flexion at final follow-up was 108 o . One case of superficial infection settled with antibiotics and one case required manipulation under anaesthesia to regain flexion which was lost in the initial follow-up since the patient was not adherent to the postop protocol. Mean follow up of the patients under study was 2.6 yrs (Range 2-5 yrs). Out of 32 cases we achieved 22 cases with excellent results and Good in 9 case and Fair in 1 case based on criteria by Judet. Conclusion: Judet's technique of Quadricepsplasty by disinsertion and muscle sliding is a useful technique in fixed flexion deformity of knee extension commonly seen in patients undergoing indigenous method of treatment and limb reconstruction surgery after a prolonged immobilisation of Knee due to conservative management of fractures around knee or application of external fixators.

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“…The postoperative care after quadricepsplasty is very important if the flexion is to be maintained without loss of active extension [6,9]. Exercises with CPM machine and strengthening exercises of the quadriceps must be performed intensively for 6 weeks after the surgery [10,11].…”

Section: Discussionmentioning

confidence: 99%

Judet's Quadricepsplasty for Extension Contracture of the Knee (Stiff Knee)

Bari¹

2015

MOJOR

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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.

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Quadricepsplasty after War Fractures

Cited by 13 publications

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Effects of Judet Quadricepsplasty in the Treatment of Post‐traumatic Extension Contracture of the Knee

Effects of Judet Quadricepsplasty in the Treatment of Post‐traumatic Extension Contracture of the Knee

Functional results of judet’s quadricepsplasty in the management of fixed flexion deformity of knee

Judet's Quadricepsplasty for Extension Contracture of the Knee (Stiff Knee)

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