Introduction

External fixation (EF) devices are commonly used in the management of complex skeletal trauma, as well as in elective limb reconstruction surgery for the management of congenital and acquired pathology. The subsequent removal of an EF is commonly performed under a general anaesthetic in an operating theatre. This practice is resource intensive and limits the amount of operating theatre time available for other surgical cases. We aimed to assess the use of regional anaesthesia as an alternative method of analgesia to facilitate EF removal in an outpatient setting.

Background: Knee stiffness from peri-articular fractures, arthroplasty or limb lengthening surgery, if intractable after an extensive programme of physiotherapy, may be resolved by quadricepsplasty. We describe the recovery of knee function in a cohort of 12 patients who underwent a Judet quadricepsplasty for loss of knee flexion.

Material and Methods: 12 adult patients underwent a Judet quadricepsplasty for recovery of knee flexion range. The causes of stiffness were trauma, arthroplasty, infection and limb lengthening surgery. A protocol of continuous passive knee movement under epidural analgesia was maintained after surgery. Continuous passive motion was continued at home for a further 4–6 weeks together with regular out-patient physiotherapy attendances. Outcome measures were range of movement, extensor lag, a modified WOMAC score for physical function, KINCOM data (with the contralateral limb as control), SF-36 and complications of surgery.

Results: There were 11 male patients and 1 female. The mean age was 30 years (20–71). The median period of follow-up was 3 years (0.8–7 years). The difference between pre-operative and final knee motion ranges was statistically significant (p=0.0048). The medians for flexion before surgery was 41 degrees (SD=18; at surgery 110 degrees (SD =15); final follow-up 105 degrees (SD=20). Extensor lag after surgery was 27.5 degrees (SD18) reducing 3.5 degrees (SD=3.5) finally. KINCOM data against a contralateral control showed a highly significant difference (p< 0.001) in quads strength. The medians for the WOMAC score was 38; PCS of the SF36 34.7 (SD13) and the MCS 53.7 (SD 13). Wound complications occurred in 7 patients and three needed further surgery.

Conclusion: Improvement in knee flexion after a Judet quadricepsplasty is maintained at one year. Extensor lag is common after the procedure but recovers. Most patients found the improvement beneficial but objective measures of knee function showed a return to normal had not been achieved.