Quadricepsplasty For 🦵Knee Stiffness Post Surgical Rehabilitation - Physiotherapy💯 - Treatments♥️ скачать в хорошем качестве

Quadricepsplasty For 🦵Knee Stiffness Post Surgical Rehabilitation - Physiotherapy💯 - Treatments♥️

As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Stiffness of the knee after trauma and/or surgery for femoral fractures is one of the most common complications and is difficult to treat. Stiffness in extension is more common and can be reduced by vigorous physiotherapy. If it does not improve then quadricepsplasty is indicated. The present study was undertaken to evaluate the results of Thompsons quadricepsplasty. Materials and Methods: Twenty-two male patients (age range 20-45 years) with posttraumatic knee stiffness following distal femoral fractures underwent Thompson's quadricepsplasty where knee flexion range was less than 45°. The index injury in these patients was treated with plaster cast (n=5), plates (n=3), intramedullary nailing (n=3) and external fixator for open fractures (n=9). Thompson's quadricepsplasty was performed in all the patients using anterior approach, with incision extending from the upper thigh to the tibial tubercle. Release of rectus femoris from underlying vastus intermedius and release of intraarticular adhesions were performed. After surgery the patients needed parenteral analgesia for three days and then oral analgesics for three weeks. Active assisted knee mobilization exercises was started on the first postoperative day. Continuous passive motion machine was used from the same day. Supervised physiotherapy was continued in hospital for six weeks followed by intensive knee flexion and extension exercise including cycling at home for atleast another six months. Results: Out of 22 patients, 20 had excellent to good results and two patients had poor results using criteria devised by Judet. One poor result was due to peroperative fracture of patella which was then internally fixed and hence the flexion of knee could not be started immediately. There was peroperative avulsion of tibial tuberosity in another patient who finally gained less than 50° knee flexion and hence a poor result. Conclusion: Thompsons quadricepsplasty followed by a strict and rigourous postoperative physiotherapy protocol successfully increases the range of knee flexion. Keywords: Knee stiffness, Thompson's quadricepsplasty, continuous passive motion External fixators with or without crossing the knee joint are commonly used in open fractures of distal femur.1 In such cases chances of knee stiffness are high. Knee stiffness is one of the most common complications following intramedullary or extramedullary fixation for distal femoral fractures. Knee flexion less than 45° causes problems in gait and hindrance in day to day activities. Some degree of knee movements can be increased by gentle manipulation under anesthesia but there are chances of hemarthrosis and recurrence of stiffness. Intensive physiotherapy may gain movements sufficient for routine activities only in a few cases. Quadricepsplasty is the surgical procedure required to release the quadriceps muscle in order to improve the range of knee flexion. This procedure is indicated mainly for stiffness in extension.2–4 Thompson and Judet type of quadricepsplasties are the most common surgical procedures described to treat knee stiffness, the former being more popular.5 We evaluated our results after Thompson's quadricepsplasty and physiotherapy. Go to: Materials and Methods Twenty-two male patients with posttraumatic knee stiffness with age ranging from 20 to 45 years, underwent Thompson's quadricepsplasty for severe extension contractures between March 1999 to June 2004. Fracture of the distal femur was the original injury in all these patients. All patients had less than 45° range of knee flexion. Nine patients with open fractures were treated with external fixator; eight patients developed postoperative stiffness following internal fixation in severely comminuted distal femoral fractures whereas five treated nonoperatively with plaster cast, developed residual knee stiffness. All these patients had original injuries in road-traffic accidents. The preoperative range of knee flexion ranged from 5° to 45° (average 21°). The patients were operated after at least one and a half years of original injury. A preoperative assessment as to the site of probable adhesions was made both clinically and radiologically. A note was made of side to side patellar movements, passive knee range of motion and any tightness of the rectus femoris over a healed scar due to injury, surgery or an adjoining pin tract site. Radiologically, any fracture callus, beak over the anterior surface of the distal femur or articular incongruity was adjudged to be a site of probable adhesion. All the patients were followed up for a period of more than two years (range two to five years). Surgical procedure: Patients were operated either under general (n = 2) or spinal anesthesia (n = 20) in