O2016 KNEE JOINT CONTRACTURES IN EXTERNAL FIXATION OF FEMUR – THE PROBLEM CAN BE OVERCOME

Abstract

Aims: The extensor contracture of the knee joint happens in the case of external þxation of low femoral fractures nearly in 100% of cases. This complication appears due to the þxation of soft tissues (skin, fascia, muscles) to the bone with transosseous elements Ð K-wires and S-screws. Methods: We have performed the Òlay-to-layÒ deþnition of soft tissue displacement (skin-fascia-muscles) relative to femoral bone during knee joint ßexion 90/0/0 using 15 human cadavers. The femur was divided into 17 proportional segments. The co-ordinate system included 12 positions in each segment. Results: Our data revealed that the minimal soft tissue displacement was seen in 4th and 8th positions at each tested level (0–5mm). In the positions 3 and 9 the indices were worse (4–10mm). It was stated that most of all the muscles were displaced, the skin was less displaced, and the displacement of fascia was the least. In the projection of the found positions the vessels and nerves are absent. Using the ÒMethod of Uniþed Designation of External FixationÒ (see www.aotrf.org, the chapter ÒFor the orthopedic surgeonsÒ) the possible variant of arrangement of the distal support can be represented by the following way: VII,4,110;VII,8,110;VIII, 3Ð9 or VII,9-3;VII,8,110;VIII, 3Ð9.Conclusions: The data of the experimental test were used during the treatment of 9 patients. During the whole period of þxation in the device the range of motions in the knee joint was from 80/0/0 to 110/0/0. After the dismantling of the device the whole range of motions was achieved in 2–3 weeks. There were no cases of soft tissue inßammation in the zone of exit of transosseous elements of the distal support.