Evaluation of Thompson's quadricepsplasty results in patients with knee stiffness resulted from femoral fracture

Proximal release for injections induced hip flexion contracture in a child: A case report

INTRODUCTION

Quadriceps contracture can be congenital or acquired; however, multiple intramuscular injections are one of the major identified causes of this lesion that can manifest in two forms: either isolated rectus femoris or combined with quadriceps contracture.

CASE REPORT

this article presents a case of a 9-year-old boy with a recurrent isolated rectus femoris contracture that was released proximally with a satisfactory result after one-year follow-up.

DISCUSSION

Treatment differs based on the degree of knee flexion loss and the affected muscles, as it can be either proximal release or distal quadricepsplasty. Extended physiotherapy and close follow-up are mandatory for successful treatment.

CONCLUSION

Proximal release of the hip flexion contracture with positive Ely's test can be effective in restoring knee flexion and improving function in patients with quadriceps contracture induced by iatrogenic injection.

Association Between Femoral "Spike" Size After Intramedullary Nailing and Subsequent Knee Motion Surgery

OBJECTIVES

To determine the association between displaced femoral shaft bone fragments ("spikes") seen on radiographs after intramedullary nail insertion and the need for future motion surgery.

DESIGN

Retrospective case-control study.

SETTING

Academic trauma center.

PATIENTS

We included patients with femoral shaft fractures treated with intramedullary nail insertion. Case patients (n = 22) had developed knee stiffness treated with motion surgery. The control group was a randomly selected sample (1:3 ratio).

MAIN OUTCOME MEASURES

Motion surgery to address knee stiffness. We defined a "spike distance ratio" and "spike area ratio" from initial postoperative anteroposterior and lateral radiographs. Multivariable logistic regression determined the effect of spike distance and area ratios on the likelihood of need for motion surgery, controlling for polytraumatic injuries and bilateral fractures.

RESULTS

The case group had a median femoral spike distance ratio of 1.9 [interquartile range (IQR), 1.6-2.5] compared with 1.5 (IQR, 1.2-1.8) in the control group. An increased femoral spike distance ratio was associated with increased odds of motion surgery (P < 0.01). A femoral spike distance >2 times the femoral radius had 32 times the odds (95% confidence interval, 2-752) of motion surgery compared with patients with distance ratios <1.25. Median femoral spike area ratios were similar between the case (0.2; IQR, 0.1-0.5) and control (0.2; IQR, 0.0-0.5) groups and were not associated with increased odds of motion surgery (P = 0.34).

CONCLUSIONS

A larger spike distance ratio is associated with increased odds of subsequent motion surgery.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.