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PubMed1990

Thermal enhancement of radiation-induced leg contracture.

Early and late damage in the normal tissues of the legs of mice was compared following treatment with radiation alone or radiation followed immediately by hyperthermia. Hyperthermia was given by immersing the hind leg in a water bath at 43.0 degrees, 43.3 degrees, or 43.5 degrees C for 1 hr. Damage was assayed by measuring leg contracture at various intervals from 5 to 365 days after treatment. At 5 days after treatment, only hyperthermia-induced contracture was observed. At 10 and 20 days, contracture increased with radiation dose in heated legs, but little contracture had developed in mice treated with radiation alone. By 45 through 365 days, however, contracture correlated with radiation dose both in mice treated with radiation alone as well as in those treated with radiation and hyperthermia. The greatest differential in the slopes of the dose response curves, suggesting hyperthermic radiosensitization, was seen 20 days after treatment. Nevertheless, at 365 days, contracture was still significantly greater in the mice treated with radiation and hyperthermia (43.5 degrees bath) than in the irradiated controls. Thermal enhancement ratios (TERs) were calculated from LCD50 values (LCD50 = radiation dose that would give a stated level of leg contracture in 50% of the mice). For greater than or equal to 3 mm contracture, TERs were 4.1 to 7.9 at 30 days, depending on bath temperature, but only 1.1 to 1.5 at 365 days. For an isoeffect of greater than or equal to 7 mm contracture, TERs were 1.9 to 5.3 at 30 days, and 0.8 to 1.8 at 365 days. Thus, contracture was enhanced more at 20 to 30 days after treatment with radiation and hyperthermia than at 120 through 365 days. Radiation damage not only appeared earlier in mice treated with hyperthermia than in those treated with radiation alone, but after the highest temperature tested (43.5 degrees bath), contracture was greater from 5 through 365 days after treatment than in controls treated with radiation alone.

Animals↗
PubMedDate not supplied

Correlation of flexion contractures with upper extremity function and pain for spinal muscular atrophy and congenital myopathy patients.

To ascertain the patients' perception of the consequences of elbow flexion contractures and better understand the circumstances at their inception, we surveyed 405 spinal muscular atrophy and congenital myopathy patients. Diagrams of various elbow angles and questions concerning the effect of elbow contractures on daily activities were part of the survey. Of 108 completed responses, effectively a 24% response rate, 49 reported elbow flexion contractures. Thirteen of the 49 patients reported first noting them during extended periods of inactivity. Elbow flexion contractures greater than 25 degrees were intractable and were reported to hamper 17% (77 of 410) of specifically considered daily activities for the 49 subjects. Twenty-nine of the 49 (59%) subjects with contractures complained of contracture-associated hindrance of at least one daily function. Perceived contracture-associated difficulties increased significantly as a function of contracture severity. Elbow contractures were perceived to be useful by 12% of the respondents. The correlation between contracture severity and upper limb discomfort was also striking. We conclude that elbow flexion contractures are common and perceived to be associated with disability and discomfort for about one-half of spinal muscular atrophy and congenital myopathy patients.

Activities of Daily Living↗
PubMed1999

The use of skin grafts in postburn contracture release: a 10-year review.

Postburn scarring and contracture affecting function remain the most frustrating late complications of burn injury. Various techniques are used to release contractures; the choice depends on their location and/or the availability of unaffected skin adjacent to the contracture or elsewhere. A retrospective review was carried out of the case notes of patients who had skin grafting for the release of postburn contracture at the Burns Unit, City Hospital, Nottingham between May of 1984 and August of 1994 to evaluate the experience over this period. Information was obtained about the burn injury, contracture site, interval between burn and release of contracture, indication, age at first release, intervals between releases, operative details (donor and graft sites), complications and nonoperative treatment, and follow-up to the end of the study period. A total of 129 patients underwent skin grafting for release of contractures as opposed to any other method of correction. Full-thickness skin grafts were used in 81 patients (63 percent) and split-thickness skin grafts in 26 (20 percent). Twenty-two patients (17 percent) had both types used on different occasions. Flame burns (41 percent) were the most common causes, followed by scalds (38 percent). Two hundred thirty-nine sites of contracture were released, with the axilla (59) and the hand/wrist (59) being the most common sites involved, followed by the head/neck region (42). It was found that for the same site, release with split-thickness skin grafts was associated with more rereleases of the contracture than with full-thickness skin grafts. Also, the interval between the initial release and first rerelease was shorter than with full-thickness skin grafts (p < 0.048). It was also noted that children required more procedures during growth spurts, reflecting the differential effect of the growth of normal skin and contracture tissue. Patients reported more satisfaction with texture and color match with the full-thickness skin grafts. There was comparable donor-site and graft morbidity with both graft types. The use of skin grafts is simple, reliable, and safe. Whenever possible, the authors recommend the use of full-thickness skin grafts in preference to split-thickness skin grafts in postburn contracture release.

Adolescent↗
PubMedDate not supplied

The level of anti-topoisomerase I antibodies highly correlates with metacarpophalangeal and proximal interphalangeal joints flexion contractures in patients with systemic sclerosis.

BACKGROUND: It is found that an antibody directed against DNA topoisomerase I (anti-topo I abs) is detected almost exclusively in systemic sclerosis (SSc). These antibodies are predictors of pulmonary fibrosis and peripheral vascular disease. OBJECTIVE: Metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints flexion contractures are assessed as markers of active SSc. The aim of this study was to find out is there any relationship between anti-topo I abs and MCP and PIP joints flexion contractures. METHODS: Twenty-eight patients with active disease who fulfilled the American College of Rheumatology criteria for SSc were included in this study. Twenty eight healthy control subjects were also investigated. Clinical and radiological assessments of the hands were carried out. The flexion ranges in the 8 finger joints by goniometric measurement were obtained. Anti-topo I abs with an enzyme linked immunosorbent assay (ELISA) were measured. RESULTS: MCP and PIP joints flexion contractures and the levels of anti-topo I abs were significantly higher in patients with systemic sclerosis than in healthy control. The anti-topo I abs were found in 16 of 28 patients with systemic sclerosis. Sixteen of 28 patients with active disease had MPC and proximal PIP joints flexion contractures. In 16 SSc patients with anti-topo I abs, 13 had metacarpophalangeal and proximal interphalangeal joints flexion contractures. In only 3 patients of 16 with the flexion contractures the levels of anti-topo I abs were negative. The patients with MPC and PIP joints flexion contractures had higher mean value of anti-topo I abs titers (53.718 +/-50.977 vs 8.127 +/- 8.915, P < 0.0001) than did those with no contractures. Furthermore, the titers of anti-topoisomerase I antibody positively correlated with the flexion contractures (r = 0.4252, P = 0.0241). Radiologically, joint space narrowing and flexion contractures of the fingers were seen significantly more frequently in the SSc patients with anti-topo I abs (P < 0.05). CONCLUSION: Serum level of anti-topoisomerase I antibodies is in direct relationship with MPC and PIP joints flexion contractures.

Adult↗
PubMed2006

Biomechanical characterization and clinical implications of artificially induced toe-walking: differences between pure soleus, pure gastrocnemius and combination of soleus and gastrocnemius contractures.

The purpose of this study was to characterize biomechanically three different toe-walking gait patterns, artificially induced in six neurologically intact subjects and to compare them to selected cases of pathological toe-walking. The subjects, equipped with lightweight mechanical exoskeleton with elastic ropes attached to the left leg's heel on one end and on shank and thigh on the other end in a similar anatomical locations where soleus and gastrocnemius muscles attach to skeleton, walked at speed of approximately 1m/s along the walkway under four experimental conditions: normal walking (NW), soleus contracture emulation (SOL), gastrocnemius contracture emulation (GAS) and emulation of both soleus and gastrocnemius contractures (SOLGAS). Reflective markers and force platform data were collected and ankle, knee and hip joint angles, moments and powers were calculated using inverse dynamic model for both legs. Characteristic peaks of averaged kinematic and kinetic patterns were compared among all four experimental conditions in one-way ANOVA. In the left leg SOL contracture mainly influenced the ankle angle trajectory, while GAS and SOLGAS contractures influenced the ankle and knee angle trajectories. GAS and SOLGAS contractures significantly increased ankle moment during midstance as compared to SOL contracture and NW. All three toe-walking experimental conditions exhibited significant power absorption in the ankle during loading response, which was absent in the NW condition, while during preswing significant decrease in power absorption as compared to NW was seen. In the knee joint SOL contracture diminished, GAS contracture increased while SOLGAS contracture approximately halved knee extensor moment during midstance as compared to NW. All three toe-walking experimental conditions decreased hip range of motion, hip flexor moment and power requirements during stance phase. Main difference in the right leg kinematic and kinetic patterns was seen in the knee moment trajectory, where significant increase in the knee extensor moment took place in terminal stance for GAS and SOLGAS experimental conditions as compared to SOL and NW. The kinetic trajectories under SOL and GAS experimental conditions were qualitatively compared to two selected clinical cases showing considerable similarity. This implies that distinct differences in kinetics between SOL, GAS and SOLGAS experimental conditions, as described in this paper, may be clinically relevant in determining the relative contribution of soleus and gastrocnemius muscles contractures to toe-walking in particular pathological gait.

Adaptation, Physiological↗
PubMed1988

Caffeine- and potassium-induced contractures of mouse isolated soleus muscle: effects of verapamil, manganese, EGTA and calcium withdrawal.

1. The effects of verapamil, manganese, EGTA and Ca2+-withdrawal on caffeine and potassium-induced contractures of the mouse isolated soleus muscle have been studied. All four treatments profoundly inhibited, in concentration-dependent manner, both K+- and caffeine-induced contractures, and recovery from these treatments was slight. 2. Caffeine (5.14-51.4 mmol/l), elicited biphasic contractures, characterized by an initial phasic, and subsequent tonic contractures. K+-induced contractures were monophasic except at the higher concentrations (53.4-214 mmol/l), when biphasic responses were also recorded. The biphasic K+ contracture had a time course similar to the caffeine-induced response. 3. Both phases of the caffeine and K+ responses were abolished by the introduction of CA2+-free Krebs'-Henseleit solution (KHS). Increasing [Ca2+]0 from 1 to 5 mmol/l, markedly inhibited the amplitude of caffeine and K+ contractures. 4. In high [K+]0 KHS, peak contractures to caffeine were reduced to about 50% of those in normal KHS. In the presence of 15.4 mmol/l caffeine, the responses to lower concentrations of K+ (13.4-26.8 mmol/l) increased, while responses evoked by the higher K+ concentrations were depressed compared with controls in normal KHS. 5. Pancuronium or D-tubocurarine severely inhibited caffeine-induced contractures, but only slightly inhibited K+-induced responses. 6. It is suggested that both caffeine- and K+-induced contractures of the mouse soleus are dependent upon the presence of [Ca2+]0, and that these contractures possibly occurred as a result of extracellular Ca2+-influx.

Animals↗
PubMed1981

Potassium and caffeine contractures in fast and slow muscles of the chicken.

1 K+ contractures, caffeine contractures and electrical properties were studied in slow (posterior latissimus dorsi; p.l.d.) and fast (anterior latissimus dorsi; a.l.d.) chicken muscles. 2. P.l.d. K+ contractures show a transient increase of tension that relaxes spontaneously. Contractures in a.l.d. show an initial component followed by a maintained tension. 3. A.l.d. K+ contractures of similar amplitude and time course were reproduced at 4 min intervals. In p.l.d., the interval needed for full recovery is about 30 min. In Cl-free saline p.l.d. and a.l.d. K+ contractures can be reproduced at 4 min intervals. 4. The time course of repolarization after a short exposure to 160 mM-KCl was much slower in p.l.d. than in a.l.d. In Cl-free saline the time course of repolarization becomes faster in p.l.d. 5. The membrane resistance was not modified in a.l.d. and was increased in p.l.d. by Cl-free saline. The calculated Cl- conductance in p.l.d. was about 70% of the total membrane conductance. 6. In a.l.d., Mn2+, D600 and external Ca2+ reduction greatly diminishes the maintained phase of the K+ contracture leaving the initial phase almost unmodified. Under similar conditions p.l.d. K+ contractures were slightly reduced. 7. P.l.d. caffeine contractures (10-40 mM) were not maintained and they were not modified by Ca-free saline, Cd2+, Co2+, Mn2+ and D600. 8. A.l.d. caffeine contractures (2-15 mM) were maintained and were highly dependent on external Ca2+. In addition they were greatly reduced by Cd2+, Co2+, Mn2 and D600. 9. It is suggested that caffeine contractures of a.l.d. are elicited by a Ca2+ entry into the muscle from the external fluid.

Animals↗
PubMed1981

A comparison of the differential effects of nitroglycerin, nifedipine and papaverine on contractures induced in vascular and intestinal smooth muscle by potassium and lanthanum.

To elucidate the mechanisms of smooth muscle relaxant effects of nitroglycerin, the effects of this substance on the potassium contracture (K+-contracture) and the lanthanum-induced contracture (La3+-contracture) were studied using smooth muscle preparations of the canine coronary artery and colon and the findings compared with the effects of nifedipine, a representative calcium antagonistic vasodilator. The effects of papaverine, a prototype smooth muscle relaxant, were also studied. La3+-contracture was induced in a calcium-free environment with the addition of lanthanum, an effective blocker of calcium influx. In the coronary artery, nitroglycerin produced a relaxation both of the La3+-contracture not K-contracture in the colon was affected. Nifedipine did not relax the La3+-contracture in a range of doses at which K+-contracture of both types of smooth muscles was relaxed. Papaverine produced a relaxation of La3+-contracture as well as K+-contracture, in both types of smooth muscles. Unlike the mechanism related to the relaxant effects of nifedipine, which is generally admitted to be an inhibition of calcium influx, the relaxant effect of nitroglycerin was attribute to the suppression of calcium release from the intracellular store sites and/or stimulation of calcium uptake into the intracellular store-sites. Papaverine was assumed to produce a relaxation through augmentation of the calcium binding to the intercellular store sites for calcium as well as through inhibition of the calcium influx.

Animals↗
PubMed1984

Mechanisms of slow contracture induced by potassium and caffeine in skeletal muscle of the dog.

Effects of diltiazem (3 micrograms-0.3 mg), verapamil (3 micrograms-0.3 mg), tetracaine (30 micrograms-3 mg), MnCl2 (0.1 mg-10 mg) and CaCl2 (0.1 mg-10 mg) on the skeletal muscle contracture induced by KCl and caffeine infusions were studied in the isolated, blood-perfused canine diaphragm preparation. All drugs were injected intra-arterially. Continuous intra-arterial infusion of KCl (50-100 mg/min) produced a biphasic contracture, which was characterized by a fast phasic contracture and a following tonic contracture. All drugs tested in this study except for CaCl2 produced a dose-dependent relaxation in the state of tonic contracture induced by KCl infusion. Dose-response curves for the relaxation of muscle to these drugs were all in parallel. Diltiazem and verapamil were equipotent and were about 10 and 30 times more potent than tetracaine and MnCl2 on a weight basis. Conversely, CaCl2 produced a contractile response in a dose-dependent manner. On the other hand, diltiazem, verapamil and CaCl2 had almost no effect on contracture induced by continuous intra-arterial infusion of caffeine (20 mg/min). MnCl2 produced a slight relaxation in the caffeine-contracture with much higher doses than those against potassium-contracture. However, tetracaine produced a dose-dependent relaxation of caffeine-contracture. Thus, the results suggest that the entry of external calcium plays an essential role in the potassium-induced tonic contracture and that the potassium- and caffeine-contractures were maintained by different mechanisms.

Animals↗
PubMed1983

Flexion contractures of the knee following poliomyelitis.

Contractures of the knee after poliomyelitis are common in children in developing countries and treatment, particularly that of severe contractures, presents a surgical challenge. This paper describes a new method for correcting contractures of the knee. Mild contractures need manipulation only and a plaster cast. Moderate contractures are treated by a partial soft-tissue release of the hamstrings and fascia lata followed by gradual stretching of the remaining soft-tissues by manipulation and plaster. Where the contracture is severe, skeletal traction is used through Steinmans pins inserted into the tibia and os calcis. One hundred and thirty-six knees with varying degrees of contracture were treated by these methods. Full correction was achieved and then maintained by plaster immobilisation, physiotherapy and calipers. This prevented recurrence during an average follow-up period of two and a half years. The severity of the contracture of the knee was in direct proportion to the severity of associated flexion-abduction contractures at the hip and equinus deformity at the ankle, the degree of muscle imbalance. All of the contractures of the hip and some of the ankle (46.8%) needed simultaneous operative correction. The basic method is technically simple, requires no special equipment and the results recommend its use particularly in developing countries.

Adolescent↗
PubMed1984

Leg contracture in mice: an assay of normal tissue response.

Leg contracture, defined as the difference in extensibility of the control and irradiated hind legs of mice, was found to correlate with single doses of radiation from about 20 to 80 Gy. The time of development of the early phase of the response coincided with that reported for the appearance of the acute skin response, and in some cases, partially reversed as this reaction healed. The contracture then progressed again at a moderate rate through 90 days, and then more slowly through one year. Skin contraction, measured by decrease in intertattoo distance, was assayed in the same mice. It followed the same time course as leg contracture, but had a different dose-response relationship. Maximal contraction occurred following doses of 30 Gy or more, reaching this level sooner following higher doses. The early reactions in individual mice were not reliable in predicting late response for either assay. To determine the contribution of skin contraction to the overall leg contracture response, mice were sacrificed and the leg contracture measured before and after the removal of the skin of the leg. After doses of up to 30 Gy, little contracture remained from skinning the leg, indicating that skin contraction was largely responsible for leg contracture in this dose range. After doses of about 45 Gy and above, some contracture remained in the skinned legs, although less than in intact legs. This indicated that injury to the deeper tissues of the leg as well as to the skin was responsible for contracture at these higher doses. There was little or no enhancement of either skin contraction or leg contracture by the hypoxic cell sensitizers metronidazole or misonidazole.

Animals↗
PubMed1986

[Contracture test with ionophore A 23187 for the diagnosis of malignant hyperthermia].

The results are reported of the contracture test obtained by using the calcium ionophore A 23187 (Calcimycin) in two patients, the son (A) and the mother (B). The past history of patient A revealed the occurrence of an impending malignant hyperthermia crisis during induction of anaesthesia in 1975. The A 23187 contracture test confirmed the presence of the malignant hyperthermia trait in patient A, whose muscle biopsy had been submitted to the caffeine contracture test, according to Ellis' technique, and found to be positive in the presence of 1 mmol of caffeine in the tissue bath; the contracture test could not be completed with a halothane contracture test, due to the impaired viability of the muscle fibres obtained. On the reverse, the mother (patient B) was found to be negative to the tests applied: the caffeine contracture test, the halothane contracture test and the contracture test performed with the calcium ionophore A 23187. It is suggested the A 23187 contracture test be added to the contracture tests as defined by the European Malignant Hyperpyrexia Group. This test could be of great help in identifying the percentage of relatives of MHS ("malignant hyperthermia susceptible") patients found to be MHE ("malignant hyperthermia equivocal").

Adolescent↗
PubMed1998

Factors associated with contractures in acute spinal cord injury.

The purpose of this study was to examine the occurrence of contractures in acute SCI and clarify possible contributing factors such as early versus late admission, level of injury, completeness of the lesion, pressure ulcers, spasticity, co-existent head injury, extremity fractures, heterotopic ossification (HO), peripheral nerve injury, and shoulder pain. The records of all patients (n = 482) admitted between 1990 and 1995 with acute SCI to a model SCI system were reviewed. Of 482 patients 44 (9%) (33 male, 11 female) developed contractures during their initial hospitalization. There were 30 tetraplegic and 14 paraplegic patients. Thirty-four patients had complete and 10 patients had incomplete lesions. The percentage of occurrence of contractures among patients admitted to the model system on the day of injury was 7.6% and among those admitted between 2 and 60 days of the injury was 15% (P = 0.05). Patients with a pressure ulcer (14.1%) were significantly more likely to have a contracture than patients without a pressure ulcer (7.1%) (P = 0.05). Contractures were also more common in patients with spasticity requiring medication; 12.7% of patients with spasticity compared to 7.8% without spasticity, had contractures (P < 0.05). Patients with a co-existent or suspected head injury (15%) were more likely to have contractures than patients without it (7.4%)(P < 0.05). Eighteen patients with a contracture had HO, extremity fracture, peripheral nerve injury or reflex sympathetic dystrophy. In conclusion, this study is one of the first to demonstrate a significant association of contractures in acute SCI with pressure ulcers and co-existent head injury and reaffirms the importance of early admission to a coordinated SCI center in the prevention of contractures.

Acute Disease↗
PubMed2002

Surgical procedure for flexion contracture and recurvatum in total knee arthroplasty.

A specific protocol for dealing with flexion contracture and recurvatum in total knee arthroplasty surgery was evaluated. In cases of flexion contracture, this protocol included choosing the larger femoral size when the femur was between sizes to make the flexion space smaller and to allow overresection of the tibial surface to correct the flexion contracture. In all cases, bone resection was done first, osteophytes were resected next, and ligaments were balanced after the trials were in place. Extra bone was resected from the distal femur to correct residual flexion contracture only if ligament balancing failed to correct the deformity. In cases of recurvatum, the smaller femoral size was chosen to enlarge the flexion space, allowing underresection of the tibia to stabilize the knee in extension. The cutting guides were positioned so that 3 to 5 mm less than the distal thickness of the femoral component was removed to stabilize the knee in extension. To evaluate this protocol, a computerized database was used to review records of 530 patients (552 knees) who had flexion contracture (542 knees) or recurvatum (10 knees) before surgery. Ligament release and correction of varus or valgus contracture corrected flexion contracture to less than 3 degrees in 515 knees (95%). Sixteen knees (3%) had release of the posterior capsule to correct residual flexion contracture, and 11 knees (2%) required overresection of the distal femoral surface to achieve correction of flexion contracture. By 1 year the flexion contracture was 2 degrees +/- 1 degree. In the knees with preoperative recurvatum, none had residual recurvatum at the conclusion of surgery, and none had recurrent deformity. None of the knees required a hinge or a stabilized component with a highly conforming central post.

Aged↗
PubMed2003

Shoulder contracture and osseous deformity in obstetrical brachial plexus injuries.

BACKGROUND: The purposes of this study were to determine the prevalence of and the association between shoulder contracture and osseous deformity in a cohort of children with an obstetrical brachial plexus injury and to identify the risk factors for these complications. METHODS: In a retrospective cohort study, all children with an obstetrical brachial plexus injury who had been born between January 1991 and January 1998 at one academic medical center and all those with the same diagnosis who had been born elsewhere during the same period and were referred to the medical center within six weeks after delivery were evaluated at fixed time-intervals by one examiner. The patients underwent a final orthopaedic, neurological, and radiographic examination at a mean age of 3.7 years (range, one to seven years). Shoulder contracture was defined as a decrease in the passive range of motion in one or more directions compared with the range on the unaffected side. Osseous deformity was defined as a nonspherical humeral head or an abnormal glenoid. RESULTS: The prevalence of a shoulder contracture of >10 degrees was 56% (twenty-nine of fifty-two patients), and the prevalence of an osseous deformity was 33% (sixteen of forty-eight patients with complete radiographic follow-up). In the children in whom complete neurological recovery was delayed (i.e., recovery was more than three weeks after birth), the prevalence of shoulder contracture was 54% (thirteen of twenty-four patients) and the prevalence of osseous deformity was 26% (six of twenty-three patients). A strong association was noted between shoulder contracture and osseous deformity (p = 0.004). Directly after birth, the presence of a clavicular fracture was the only factor that was associated (p = 0.016) with the development of an osseous deformity (but not with a shoulder contracture). At a later stage, speed and extent of neurological recovery were related to shoulder contracture and osseous deformity. An asymmetric appearance was noticed in children who had a contracture, including those who had complete neurological recovery. CONCLUSIONS: The prevalence of shoulder contracture and osseous deformity in children with obstetrical brachial plexus injury was high, even in those with complete neurological recovery. These complications were strongly associated with one another. No symptom that appeared immediately after birth was identified as a factor that would predict the development of future shoulder contracture. A clavicular fracture was found to be significantly associated with the development of an osseous deformity at a later stage.

Birth Injuries↗
PubMed2006

Treatment of knee flexion contracture due to central nervous system disorders in adults.

BACKGROUND: Studies concerning adult patients with spastic flexion contracture of the knee are rare. Such patients frequently have cutaneous and vascular complications as well as recurrence of the contracture after treatment. We present a strategy consisting of simultaneous correction of all deformities of both lower limbs, distal hamstring releases, and application of femorotibial external fixation when extension of the knee is limited by excessive posterior soft-tissue tension. METHODS: A consecutive series of fifty-nine patients (ninety-seven knees) between the ages of twenty-one and seventy-seven years received surgical treatment for a flexion contracture of the knee secondary to neurological impairment. The flexion contracture was bilateral in thirty-eight patients. Preoperatively, the mean flexion contracture angle was 69 degrees and the mean passive range of motion was 61 degrees. The contracture was corrected, through medial and lateral approaches, with distal hamstring lengthening. A posterior capsulotomy was performed in thirty-five knees. Full extension of thirty-four knees was achieved intraoperatively. In seventy-seven knees, partial correction was maintained with a unilateral external fixator, and passive and active mobilization was performed four times daily after temporary removal of the spanning external fixator rod. RESULTS: At the time of final follow-up, ranging from one to five years postoperatively, the mean residual flexion contracture was 6.2 degrees. Forty-five knees had complete extension, and thirty-nine knees had a residual flexion contracture of <10 degrees. No recurrence of the flexion contracture or instability was noted in any knee at the time of follow-up. There were four cutaneous complications but no vascular or neurological complications. CONCLUSIONS: We believe that our surgical strategy for correction of fixed knee flexion contracture in adult patients is safe and effective. The correction improves nursing care and sitting posture, facilitating the upright position of patients who are unable to walk, and improves walking ability for patients who are able to walk.

Adult↗
PubMed2001

[Supracondylar femoral extension osteotomy for knee flexion contracture correction in poliomyelitic conditions].

PURPOSE OF THE STUDY: Knee flexion contracture due to quadriceps paralysis is a major handicap in poliomyelitis patients. The patient has to stabilize the knee with the ipsilateral hand to achieve weight bearing and the deformed knee precludes use of orthopedic devices. Extension can be achieved with supracondylar femoral osteotomy if the knee flexion contracture is less than 30 degrees. We assessed functional and anatomic outcome. MATERIAL AND METHODS: We reviewed the files of 87 patients who had undergone 93 supracondylar femoral osteotomies for knee flexion contracture (6 bilateral cases); mean age was 18 years and mean flexion was 25 degrees. The surgical correction was achieved by diaphyseal metaphyseal impaction with resection of an anterior wedge and preservation of the posterior component of the articulation. If some gluteus maximus activity was retained and the tibiotarsal joint was in a slightly equine position, weight bearing in a stable locked position became an automatic postural event even in case of total paralysis of the quadriceps. Osteotomy was not possible if the contracture flexion was greater than 30 degrees due to excessive tension on the vaculonervous bundles. The procedure was equally impossible in children under 12 years of age due to the risk of recurrence subsequent to migration and callus remodeling with bone growth. RESULTS: Complete extension of the knee was achieved peroperatively in all cases. The most serious complications were three cases of septic arthritis that led to an irreducible stiff knee. In addition, we had two cases of transient paralysis of the common fibular nerve that recovered spontaneously. Bone fusion was achieved in all cases within 30 days. Recurrent flexion contracture was observed in 5 cases and required a revision using the same procedure in 3 or them. Postoperatively, the amplitude gained in knee extension corresponded to the amplitude lost for flexion. Sixty-three patients were able to walk independently without manual stabilization and a knee extension orthesis could be installed for 19 others. Three patients were still unable to walk despite the correction of the knee flexion contracture due to failure of poorly accepted orthopedic devices. DISCUSSION: Several conservative methods (physiotherapy, manipulations, successive corrective casts) and surgical procedures (release of posterior soft tissues, Ilizarov technique) have been proposed for the correction of paralytic knee flexion contracture. Supracondylar femoral osteotomy for extension can be useful after the end of growth if the flexion contracture remains below 30 degrees. The procedure is simple and morbidity is relatively low compared with the regularly successful results. When the flexion contracture exceeds 30 degrees, the supracondylar osteotomy cannot be employed due to the risk of stretching the vasculonervous bundles and due to the instability and disorganization of the lower femur. Progressive correction can be proposed for these patients: regular monitoring of the neurological and vascular situation is required. Functional improvement is considerable after correction of knee flexion contracture. The patients can walk more easily, no longer need to stabilize their knee with their hand, and can benefit from orthopedic devises due to the more favorable biomechanical conditions.

Activities of Daily Living↗
PubMed1996

Gold ion inhibits silver ion induced contracture and activates ryanodine receptors in skeletal muscle.

Effects of Au3+ on Ag(+)-induced contractures and Ca2+ release channel activity in the sarcoplasmic reticulum were studied in frog skeletal muscles. Single fibres spontaneously produced phasic and tonic contractures upon addition of 5-20 microM Ag+ or more than 50 microM Au3+. Simultaneous application of 5 microM Ag+ and 20 microM Au3+ inhibited contractures induced by Ag+. Au3+ applied immediately after development of Ag(+)-induced contractures shortened the duration of the phasic contracture and markedly decreased the subsequent tonic contracture. Pretreatment of fibres with Au3+ inhibited the Ag(+)-induced phasic contracture. Ca2+ release channels incorporated into planar lipid bilayers were activated in response to Au3+ at 20 to 200 microM. A close relationship was observed between Ca2+ release channel open probability and amplitude of the Au(3+)-induced tonic contracture. Channel activity was inhibited by 5 microM ruthenium red. We conclude that extracellular Au3+ at low concentrations modifies the interaction of Ag+ with voltage sensors in the transverse tubules to inhibit the Ag(+)-induced contracture and, if it enters the cell, Au3+ may directly activate the sarcoplasmic reticulum Ca2+ release channel to partially contribute to the tonic contracture.

Animals↗