Abstract
Purpose
The treatment of children with contractures involving the lower limbs is challenging. Many are confined to wheelchairs for several years till their potential to ambulate is discovered. The aim is to review the treatment and outcome of eight children treated for contractures and deformities of the lower limbs following confinement to wheelchairs.
Methods
Eight children aged 4–14 years were treated for contractures of the hips, knees and feet between 2005 and 2011. The initial diagnosis was not made in 5 children. All children had never walked previously. Four patients were labelled “cerebral palsy”.
All children were seen with a physiotherapist to assess their walking potential. Genetic and paediatric medical assessment was also made. Final diagnosis revealed arthrogryposis (n = 3) pterygium syndrome (n = 1) calcinosis cutis (n = 1) viral neuropathy (n = 1) and cerebral palsy (n = 2)
Clinically all children were assessed to have good upper limb function for use of crutches. Surgical correction of the feet was required in 6 patients. Extension osteotomies of the knees were done in 8 patients following serial plaster cast treatment and hamstring release. Hip releases were done in 4 patients.
Results
The osteotomies healed well following above knee cast immobilisation. All patients are ambulant with above knee calipers, anterior knee straps and boots. Two children required repeat extension osteotomies. Follow up ranges between 8 months to 5 years.
Conclusion
Patients with contractures of the lower limb should have careful clinical assessment. If upper limb function is suitable for holding crutches and the patients have the potential to kneel with the body erect, careful preoperative planning should be undertaken to improve the foot for weight bearing and the knees with extension osteotomies and ambulation. Accurate diagnosis is essential
