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Casestudies  >  Poliomyelitis  >  SupraCondylar Osteotomy for correction of Fixed Flexion deformity and Hand-to-knee gait in Polio
 
Poliomyelitis
 
 

fixed flexion deformity is the commonest deformity in Poliomyelitis. This is caused by a paralytic weakness of the Quadriceps muscle.                    the Fixed Flexion Deformity causes extra energy expenditure during walking and hence tiredness, a hand-to -knee gait and protrusion of buttocks and an ugly gait.                          

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32 year old lady suffering from fixed flexion deformity due to Poliomyelitis of almost 35 degrees suffered from  a hand to knee gait and severe tiredness on walking. She could walk no further than half a kilometer by which time she felt
very tired. The gait was also ugly with the buttocks protruding out from behind.

If the hand is not applied to the knee the knee buckles forwards and the person can fall down. The way they prevent this is by putting a hand in the front of the knee joint which stabilizes the knee from the front in absence of the Quadriceps muscle strengh.

                    Ilizarov fixator montage on femur for SupraCondylar Osteotomy. The osteotomy is performed with a very small 5 mm incision which can hardly be seen. The fixator permits walking as well as knee bending.                                             xray shows a Supracondylar osteotomy fixed with the Ilizarov fixator. This is the most reliable method of fixation of the osteotomy and allows accurate and complete correction of the deformity without worries of nerve and blood vessel damage. It allows knee bending as well as walking and compression at osteotomy site to ensure early and sound union

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The correction of this deformity was performed with the Ilizarov Fixator gradually over a few days to prevent Neuro-Vascular deficit. The osteotomy was made with a small incision which can hardly be seen. The patient could walk easily during treatment, without much pain.
The manuvre is the angulation-translation one which is based on the hinge at the level of the knee joint and a supracondylar osteotomy is done above which is translated posteriorly.
This helps the centre of gravity of the body to pass in front of the knee which results in stability in absence of the quadriceps.

    full correction of fixed flexion deformity of the knee with straightening         full movements including sitting cross legged on floor after supracondylar osteotomy         xray shows accurate correction of the deformity without removal of a bony wedge, showing the posterior translation which allows the centre of gravity of body to pass in front of knee to stabilize it.      

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At the end of 12 weeks the osteotomy was healed and fixator removed to give complete correction of the flexion deformity.The patient had full function of the knee including the ability to sit cross legged on the floor. The x-rays show full correction of the flexion deformity and the flash animation shows how it protects the knee from buckling.