Guided growth for fixed knee flexion deformity

Journal of Pediatric Orthopedics
Joshua Klatt, Peter M Stevens

Abstract

Fixed knee flexion deformity (FKFD) is an insidious problem that may complicate the management of patients with neuromuscular compromise due to cerebral palsy, spina bifida, arthrogryposis, and other conditions. The energy costs associated with crouch gait may become prohibitive and, with the inexorable progression of fixed knee flexion, secondary pain may ensue as a result of fragmentation of the patella and/or tibial tubercle. Concomitant or compensatory flexion deformity of the hips and lumbar lordosis may develop, along with "pseudo equinus" of the ankles. Recommended treatments for FKFD have included bracing; physical therapy; and, in recalcitrant cases, distal femoral osteotomy, posterior release, or frame distraction. However, these latter modalities are fraught with potential complications including neurovascular damage, loss of fixation, undercorrection malunion, fracture, and recurrent deformity. Considering that FKFD is often bilateral, the complication risks for a given patient are doubled. In a previous study, the senior author reported successful hemiepiphysiodesis of the distal anterior femur using staples. However, further experience has demonstrated some of the limitations of stapling including relatively slow ...Continue Reading

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