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Noda M, Saegusa Y, Takahashi M, et al. Decreasing Complications of Quadricepsplasty for Knee Contracture after Femoral Fracture Treatment with an External Fixator: Report of Four Cases. J Orthop Case Rep. 2013;3(1):3-6
Noda, M., Saegusa, Y., Takahashi, M., Kashiwagi, N., & Seto, Y. (2013). Decreasing Complications of Quadricepsplasty for Knee Contracture after Femoral Fracture Treatment with an External Fixator: Report of Four Cases. Journal of orthopaedic case reports, 3(1), 3-6.
Noda, Mitsuaki, et al. "Decreasing Complications of Quadricepsplasty for Knee Contracture after Femoral Fracture Treatment with an External Fixator: Report of Four Cases." Journal of orthopaedic case reports vol. 3,1 (2013): 3-6.
Noda M, Saegusa Y, Takahashi M, Kashiwagi N, Seto Y. Decreasing Complications of Quadricepsplasty for Knee Contracture after Femoral Fracture Treatment with an External Fixator: Report of Four Cases. J Orthop Case Rep. 2013 Jan-Mar;3(1):3-6. PMID: 27298887; PMCID: PMC4719231.
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J Orthop Case Rep. 2013 Jan-Mar;3(1):3-6.

Decreasing Complications of Quadricepsplasty for Knee Contracture after Femoral Fracture Treatment with an External Fixator: Report of Four Cases.

Journal of orthopaedic case reports

Mitsuaki Noda, Yasuhiro Saegusa, Masayasu Takahashi, Naoya Kashiwagi, Yoichi Seto

Affiliations

  1. Department of Orthopedics, Konan Hospital 658-0064 Kamokogahara 1-5-16, Higashinada-ku, Kobe, Japan.
  2. Both are MD, Department of Orthopedic surgery, SKY Orthopedic clinic 567-0829 Futaba-tyo 10-1, Ibaraki-shi, Osaka, Japan.

PMID: 27298887 PMCID: PMC4719231

Abstract

INTRODUCTION: In performing quadricepsplasty for contracture that develops after application of an external fixator for femoral fractures, surgeons must be aware of the potential risk for re-fracture and pin-related problems. The purpose of this report is to highlight these not well-detailed complications and to discuss specific findings and treatment suggestions.

CASE SERIES: 4 men (mean age, 40 years) presenting with secondary to contracture that developed after application of an external fixator for femoral fractures were included in this study. The radiographs showed union across the fracture site however two of these patients couldn't stand on one leg raising suspicion about the union status. A computed tomographic image indeed demonstrated limited continuity of the cortex. Bone grafting was performed prior to quadricepsplasty. The mean extension and flexion before the quadricepsplasty were 0° and 57°, respectively. At the final follow-up examination, the mean active flexion of the knee had increased to 98°.

RESULTS: The incidence of re-fracture during and after quadricepsplasty has been reported to be between 10 and 25%. There are 2 preoperative features that may mislead surgeons into believing that complete union of the fractures has been attained: one is the patient's ability to stand on a single leg, and the other is the fact that plain radiographs may lend themselves to different interpretations. In such cases, computed tomography will provide evidence of the continuity of the cortical bone. Bone grafting in 2 of our patients is thought to have prevented the postoperative complications of re-fracture. Complications at pin sites induce contracture at surrounding structures. When extreme tightness of the skin is noted, a tension-releasing procedure such as a skin graft should be performed.

CONCLUSION: In conclusion, re-fracture or pin-site contracture should be carefully managed before quadricepsplasty, because the patients who need a lengthy application of an external fixator experience greater difficulty in bone healing and have more soft tissue damage.

Keywords: Quadricepsplasty; femoral external fixator

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