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Study Design Case report. Introduction Severe flexure contractures of the hand secondary to upper limb spasticity (ULS) cause pain, palmar hyperhidrosis, ulceration, and nail plate deformities. Nonoperative management includes traditional orthotic devices that can be very painful for severe contractures and Botox injections, which provide a temporary solution. Surgical treatment comprises of soft tissue releases, tendon transfers, and release of the flexor and intrinsic muscles, which can cause permanent functional problems. Case Description In a 28-year-old male, unfit for surgery, we present the first documented case report in literature of flexion contractures of the hand secondary to upper limb spasticity managed using the “Inflatable Carrot” orthosis, where other conservative measures failed. Results At 4 weeks, the pulp to palm distance improved from 0 to 2 cm. At 3 months, the patient regained normal nail plate architecture, improved hand hygiene, reduced infection and pain. The patient reported improved psychological well-being and motivation to engage further with our therapists. Conclusions The inflatable carrot provided an alternative nonsurgical solution for management of flexion contractures of the hand when surgical intervention was not considered in the patient’s best interests. Awareness of this orthosis among hand therapists and surgeons will broaden our armamentarium for this challenging clinical problem.

Background: Severe flexion contractures of proximal interphalangeal joint of fingers can significantly impair hand function, typically after burn injury recovery. Extensive surgical release exposes deep vital structures, which subsequently requires significant skin coverage. The author presents the results of using bilateral side-finger flaps (wing flaps) and full-thickness skin graft for coverage of the defects. Methods: Seven patients (8 fingers) with chronic severe flexion contractures of fingers resulting from burn injury were included. Results: Mean flexion contracture and full flexion angles of the joints were improved from 84.4°/93.7° to 4.7°/92.5° at the last follow-up visit. No major complications were observed during the postoperative follow-up period (range, 6–16 months). Conclusions: This alternative surgical technique can be successfully applied for the treatment of chronic severe flexion contractures of fingers. The advantages of this approach are the use of local flaps from injured digit, and that it can be performed as a one-session procedure.

Introduction. Cerebral palsy (CP) is the main cause of childhood neurological disability in the world. Due to the fact that the prevalence of knee contractures in children with cerebral palsy occupies the 3rd place in the structure of orthopedic pathology of the lower extremities, this topic is least covered in the scientific periodicals. Material and methods. Findings from 40 patients of the main group, aged 7-12 and having cerebral palsy (CP), were studied retrospectively. They had knee flexion contractures with patella alta. Findings of goniometry and of Gillette FAQ were analyzed before and after surgery. The Spearman coefficient was used for the correlation analysis of goniometry parameters and surgical intervention effectiveness before surgery. 35 patients having no bilateral CP damage and other diseases leading to lower limb deformities were included into the reference group. X-ray examination and goniometry assessment of a healthy limb were made in patient’s lying position on his back with passive extension; plus goniometry in a standing position with shin active extension. Results. The median of deformation angles before and after surgery was 20° and 5°, respectively (p

Im Rahmen der Totalendoprothetik des Kniegelenkes hat sich das Kinematic Alignment (KA) neben dem konventionellen Mechanic Alignment (MA) etabliert. Wie jede Technik sieht sie sich Herausforderungen gegenubergestellt. Hauptsachlich sind dies Streckdefizite und hohergradige Deformitaten. Streckdefizite werden ublicherweise durch ein dorsales Kapselrelease adressiert. Diese Technik zeigt sich aber in vielen Fallen nicht zielfuhrend. Haufig wird daher zur Korrektur, gerade bei Verwendung hergebrachter Instrumentarien, eine Proximalisierung des distalen Femurschnittes durchgefuhrt. Dies fuhrt aber regelhaft zu einer „Mid-flex“-Instabilitat. Dies wird durch das KA zwar unterbunden, die Streckhemmung bleibt dann aber weitestgehend bestehen. Hierzu wird beim KA der tibiale Schnitt distalisiert und daraufhin der Slope verringert, um keine Instabilitat des Beugespaltes zu erzeugen. Durch diese Technik kann effektiv volle Streckung erreicht werden, es verbleibt aber nicht selten eine Teilinstabilitat in 90° Beugung. Um dem zu begegnen, propagieren wir die Technik des „virtuous mistake“. Unter Beibehaltung der reinen KA-Technik werden hierbei die dorsalen Femurkondylen bewusst 2 mm weniger reseziert. Ein weiteres Problem stellen hohergradige Deformitaten dar. Hier ist die Unterscheidung von intra- und extraartikularer Deformitat von Bedeutung. Bei ersterer kann ggf. eine reine KA-Technik, oder eine „restricted-KA(rKA)“-Technik zum Einsatz kommen. Bei einer extraartikularen Deformitat ist zumeist eine Osteotomie oder ein kombiniertes Verfahren (Osteotomie und KA) indiziert.

Genitopatellar syndrome (GPS) is a rare disorder characterized by patellar hypoplasia, flexion contractures of the lower limbs, psychomotor retardation and genital and renal anomalies. We report the case of a female infant diagnosed with GPS to a KAT6B gene mutation, which was identified using whole exome sequencing.

Hyaline fibromatoses syndrome is a rare autosomal recessive disorder with very few cases reported from India till date. It is characterized by the deposition of amorphous hyaline material in the skin, bones, and viscera. It represents a disease spectrum with infantile systemic hyalinosis as the most severe form and juvenile hyaline fibromatoses (JHF) being the mild form. These conditions characteristically present with overlapping clinical features such as nodules and/or pearly papules, gingival hyperplasia, flexion contractures of the joints, and osteolytic bone defects. Identification of this condition by the treating dermatologist is important to facilitate an early diagnosis and a multidisciplinary follow-up. We report one such case of this uncommon condition– JHF.

Background Mutations in the HECT domain of NEDD4L have recently been identified in a cohort of eight patients with a syndromic form of bilateral periventricular nodular heterotopia (PVNH) in association with neurodevelopmental delay, cleft palate, and toe syndactyly (PVNH7). Methods Case report based on NGS sequencing. Results Here, we describe a girl with a novel heterozygous NEDD4L missense variant, p.Tyr679His, and characteristic clinical findings, including bilateral periventricular nodular heterotopia, cleft palate and mild toe syndactyly. Molecular testing from peripheral blood identified the healthy father to carry the NEDD4L variant in mosaic state. Notably, a previous pregnancy of the couple had been terminated due to a complex fetal developmental disorder, including hypokinesia and flexion contractures. Upon review, this affected fetus was also shown to carry the familial NEDD4L variant. Conclusion Our findings may suggest a broader spectrum of NEDD4L‐associated phenotypes, including severe prenatal neurodevelopmental manifestations, which might represent yet another genetic form of fetal hypokinesia with flexion contractures.

Contracture involving flexor aspect of the fingers is one of the common sequelae encountered after burns, infection, and trauma. In the treatment of contractures, the surgeon is often challenged by the paucity of skin flaps to cover the joint area. It is then covered with skin grafts , leading to recurrence. When there is a large discrepancy between the required and the available length of skin, traditional Z-plasty techniques fail to overcome this deficiency of the skin. We employ 2 long skin flaps to cover the joint, using all the available skin around the contracture and leaving areas on the sides of the digit that are covered by full-thickness skin grafts.

Hand burns are frequently seen in children, often resulting in digital flexion contractures. Traditional split-thickness or full-thickness skin grafts leave notably different skin texture and hyperpigmentation. The purpose of this study was to describe our operation for treating digital flexion contractures with full-thickness plantar skin grafts, and to evaluate the appearance and function outcomes. Hematoxylin and eosin staining, Masson trichrome staining and Melan A (marker of melanocyte) staining were used to evaluate palmar skin, plantar skin, groin skin and burn scars. Full-thickness plantar skin grafts were performed between 2008 and 2015 in 24 hand burn patients with digital flexion contracture. The average age at the time of surgery was 39.3 months and the average follow-up period was 5.5 years. The functional and cosmetic results were assessed. Plantar skin shared similar attributes with palmar skin histologically. Both plantar skin and palmar skin did not express melan A. All of the skin grafts survived well without hematoma, infection and necrosis. The grafts resembled the adjacent normal skin in regards to appearance and texture. The average TAM (total active movement) degree for the fingers was improved from 152.3° to 238.5°. The average VSS (Vancouver Scar Scale) score decreased dramatically from 10.4 to 1.1. Twenty one of twenty four patients (21/24, 87.5%) were very satisfied with function and appearance, and three in twenty four (3/24, 12.5%) were somewhat satisfied. This study indicates that full-thickness plantar skin grafts can achieve a satisfactory appearance and good function for hand burn child patients with digital flexion contractures.

Arthrofibrosis, as a result of osteoarthritis, after trauma, or after knee surgery, can have significant implications for patient function, satisfaction, and outcomes. When extensive conservative management fails to achieve satisfactory results, surgical intervention may be necessary. Arthroscopic techniques to release anterior adhesions are often viewed as easier and safer than posterior releases required for flexion contractures. We present our technique of a safe, effective, and reproducible arthroscopic complete posterior capsulotomy.

Flexion contractures of the knee result from a variety of perpetual insults in end-stage arthritis. They cause inefficient ambulation and pose a number of challenges for the surgeon who is performing the total knee arthroplasty. The most important aspect of the procedure is establishing the posterior recess of the knee. We provide a grading system for flexion contracture, as well as an algorithm for correcting the deformity in the operating room. Surgery is the best time to obtain full extension, so the surgeon should not leave the operating room if full extension has not been achieved.

BACKGROUND/OBJECTIVE The objective of this study was to determine whether the extended or flexed knee positioning was superior for arthrocentesis and whether the flexed knee positioning could be improved by mechanical compression. METHODS Fifty-five clinically effusive knees underwent arthrocentesis in a quality improvement intervention: 20 consecutive knees in the extended knee position using the superolateral approach, followed by 35 consecutive knees in the flexed knee position with and without an external compression brace placed on the suprapatellar bursa. Arthrocentesis success and fluid yield in milliliters were measured. RESULTS Fluid yield for the extended knee was greater (191% greater) than the flexed knee (extended knee, 16.9 ± 15.7 mL; flexed knee, 5.8 ± 6.3 mL; P < 0.007). Successful diagnostic arthrocentesis (≥2 mL) was 95% (19/20) in the extended knee and 77% (27/35) in the flexed knee (P = 0.08). After mechanical compression was applied to the suprapatellar bursa and patellofemoral joint of the flexed knee, fluid yields were essentially identical (extended knee, 16.9 ± 15.7 mL; flexed knee, 16.7 ± 11.3 mL; P = 0.73), as were successful diagnostic arthrocentesis (≥2 mL) (extended knee 95% vs. flexed knee 100%, P = 0.12). CONCLUSIONS The extended knee superolateral approach is superior to the flexed knee for conventional arthrocentesis; however, the extended knee positioning and flexed knee positioning have identical arthrocentesis success when mechanical compression is applied to the superior knee. This new flexed knee technique for arthrocentesis is a useful alternative for patients who are in wheelchairs, have flexion contractures, cannot be supine, or cannot otherwise extend their knee.

Surgeons and resident physicians in a clinic setting often visually estimate Dupuytren flexion contractures of the hand to follow disease progression and decide on management. No previous study has compared visual estimates with a standardized instrument to ensure measurement reliability.Consecutive patients consulted for Dupuytren flexion contractures of the hand had individual joint contractures estimated in degrees (°) by both a resident physician and staff surgeon. Estimates were compared with goniometer measurements to generate intraclass correlation coefficients (ICCs), and residents and surgeons were compared based on their accuracy.Twenty-eight patients enrolled in this study, which provided a total of 80 hand joints for analysis. Resident physicians achieved an ICC of 0.42, which indicates poor reliability. The hand surgeon achieved an ICC of 0.86, which indicates high reliability. The surgeon also had better accuracy than the residents.Hand surgeons should be mindful of the limitations of visual estimates of Dupuytren flexion contractures, particularly when conducted by trainees. Joint angle measurements taken for the purposes of research should be done with a goniometer at minimum.Les chirurgiens et les résidents en milieu clinique font souvent une évaluation visuelle des contractures de Dupuytren pour suivre l’évolution de la maladie et prendre des décisions thérapeutiques. Aucune étude n’a comparé les évaluations visuelles à un instrument standardisé pour garantir la fiabilité de la mesure.Des patients consécutifs qui avaient consulté en raison de contractures de Dupuytren avaient des contractures articulaires individuelles qu’un résident et un plasticien ont évaluées en degrés. Les auteurs ont ensuite comparé les résultats à des mesures goniométriques pour produire des coefficients de corrélation intraclasse (CCI), puis ont comparé la précision des résidents à celle des plasticiens.Vingt-huit patients ont participé à l’étude, pour un total de 80 articulations de la main pouvant être analysées. Les résidents ont obtenu un CCI de 0,42, ce qui fait foi d’une faible fiabilité. Le plasticien de la main a obtenu un CCI de 0,86, ce qui est indicateur d’une fiabilité élevée. Les résultats du plasticien étaient également plus précis que ceux des résidents.Les plasticiens de la main devraient être conscients des limites des évaluations visuelles des contractures de Dupuytren, particulièrement lorsqu’elles sont effectuées par des stagiaires. À tout le moins, il faudrait utiliser un goniomètre pour effectuer les mesures d’angle des articulations obtenues aux fins de la recherche.

Total knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA) has different features from those seen in patients with osteoarthritis. In 1970 85% of the patients undergoing TKA had rheumatoid arthritis. Nowadays less than 5% of the patients undergoing TKA have rheumatoid disease. An important reason for the marked decrease is the improvement of the medical treatment. Fewer patients now progress to permanent structural damage requiring arthroplasty. TKA in RA has management difficulties that are unique to the disease. These include ipsilateral hip involvement, bilaterality, anticoagulation needs, flexion contractures, rheumatoid cysts and possibly the need for synovectomy. Patients with rheumatoid arthritis are more vulnerable to both early and late infections. They require a prosthesis and technique that provide adequate flexion for activities of daily living. Their often-profound osteopenia can lead to intraoperative and postoperative fractures. Finally, their cervical spine and temporal-mandibular disease create challenging anesthetic considerations. Nevertheless, given these considerations and the degree of preoperative disability suffered by patients with rheumatoid arthritis, the results of surgery can be extremely dramatic and gratifying to both patient and surgeon.

In cases of chronic distal biceps ruptures, the combination of muscle atrophy, distal tendon retraction, and fibrosis makes primary anatomic reattachment of the tendon particularly challenging. To regain tendon length and avoid flexion contractures, reconstruction with graft augmentation has been proposed as an alternative for cases not amenable to primary repair. We describe our technique using an Achilles allograft through a modified Henry approach to reconstruct the distal biceps tendon to regain length as well as restore flexion and supination strength. With proper and detailed exposure, chronic distal biceps injuries can be reconstructed safely and efficaciously using an Achilles allograft.

Isolated adrenocorticotropic hormone deficiency (IAD) is a rare disorder with diverse clinical presentations. A 79-year-old man was bedridden for six months due to flexion contractures of the bilateral hips and knees, along with hyponatremia. He was diagnosed with IAD based on the results of endocrine tests. After one month of corticosteroid replacement, he recovered and was able to stand up by himself. Although flexion contracture is a rare symptom of IAD, steroid replacement therapy may be effective, even for seemingly irreversibly bedridden elderly patients. In bedridden elderly patients with flexion contractures, we should consider and look for any signs of adrenal insufficiency.

Genitopatellar syndrome (GPS) is mainly characterized by an absence of patellae, congenital flexion contractures of the lower limbs, psychomotor retardation, and anomalies of the external genitalia and kidneys. We report an 18-year-old female with a novel heterozygous truncating mutation in exon 17 of the KAT6B gene [MC_000010.11:c.3603_3606 del, p.Arg1201fs]. This is the first report of typical GPS in a Japanese individual. The details of our findings may contribute to elucidating the mechanism underlying GPS-specific clinical features.

Specific anatomical features of knee flexion contractures are the result of burns located on the flexion lateral joint surface (medial or lateral), or flexion medial surface (popliteal area), or all three surfaces (both lateral and medial) together. Corresponding with the scar location, three anatomical contracture types were formed: edge (lateral and medial), medial, and total. The edge contracture has a fold that is scar and skin surface surplus. The cause of the contracture is scar surface deficit of a trapezoid form on a flexion lateral surface. We showed that the best-matched flap is trapezoid-shaped and taken from the popliteal fossa. The tissue surplus is sufficient for complete contracture using trapeze-flap plasty without skin grafts and triangular flaps. Anatomy, surgical technique, and results of knee edge contracture treatment are presented in this chapter.

Knee medial contractures are formed after burns of the knee posterior surface (FM). The anatomy and treatment of this contracture type have not been explored and highlighted in the literature. When a burn wound is healing, scars form a fold that covers the entire popliteal fossa. In the fold’s sheets there is a surface deficit in length (contracture cause) and a scar surface surplus allowing medial contracture elimination with local adipose-cutaneous trapezoid flaps. The fold’s sheets have a surface deficit in length of a trapezoid form, which is the real cause of contracture. These anatomical observations enabled us to develop data that allowed us to develop a technique to convert fold sheets into trapezoid flaps and to eliminate contracture with a trapezoid flap. Rough ulcerous scar should be excised, and wound skin should be grafted. These new data are presented in this chapter.

Case: Knee flexion contractures are difficult to treat effectively. We present the case of a ten-year-old boy with a flexion contracture due to a hypertrophied ligamentum mucosum treated with an arthroscopic posterior capsular release. The patient obtained full extension and maintained it at the time of final follow-up. Conclusion: This case represents a unique cause of an impinging ligamentum mucosum and provides anecdotal support to the concept of an arthroscopic posterior capsular release as a safe and effective option for flexion contractures.

Rationale: Palmoplantar keratoderma (PPK) is a genetically heterogeneous group of skin diseases, which is characterized by erythema and hyperkeratosis. Mal de Meleda (MDM) is a rare type of PPK with an estimated prevalence in the general population of 1 in 100,000. Patient concerns: In this study, we report a MDM patient with severe lesion in skin and flexion contractures of fingers and toes. Diagnoses: MDM was diagnosed based on clinical manifestations and gene test. Interventions: This patient was treated with oral acitretin and topical tazarotene. Outcomes: Physical examinations indicated that the hyperkeratosis was in remission, but the erythema was expanding to her elbows progressively. Due to the adverse events (e.g., dry eyes and lips), the patient stopped taking the oral drug. Lessons: MDM is a rare subtype of PPK, which is inherited in an autosomal recessive pattern and has characteristics that skin lesions on hands and feet appear soon after birth and develop progressively. MDM can lead to severe flexion contractures in some cases. The reliable method for the diagnosis of MDM is gene test.

Objectives This study aims to assess the level of awareness of transtibial amputee patients on stump contractures and their compliance with efforts implemented to prevent the condition. Patients and methods This study included 50 unilateral transtibial amputees (26 males, 24 females; mean age 55.4±14.7 years; range, 18 to 78 years) who met the respondent criteria of the study. The respondents were randomly selected and were issued with a questionnaire. Results The majority of the transtibial amputees were aware of stump contracture complications. It was found that they also preferred methods of prevention which required less effort, was cost-effective, and were also practical. Conclusion More focus should be placed on contracture prevention methods which were most complied with by the patients. This is because the effectiveness of a prevention method is highly influenced by patients' compliance with the method. Patients with a higher risk of developing stump contractures should be also given more attention in post-amputation care.

Patients proposed for total knee arthroplasty (TKA) present severe pain, limited function, loss of motion, and increasing deformity.Most patients present fixed varus and valgus deformities in the coronal plane. The sagittal plane deformities are mostly flexion contractures and a few are recurvatum.

New knee brace designs are available that have the potential to improve patient outcomes relative to traditional bracing. For the indications of post-knee injury/surgery recovery, conservative management of knee osteoarthritis (OA), total knee arthroplasty (TKA) pre-habilitation, and the treatment of post-surgical extension deficits/flexion contractures, innovative new bracing designs merit review and discussion. The researchers requested information from industry brace manufacturers, and from the information received, have selected those products considered significant improvements over traditional functional brace designs for review in this article. Clinical research supporting the benefits of the innovative products listed in the article have been cited when available. The authors are both Certified Orthotists with over 50 years of combined knee bracing experience.

Flexion contractures of the wrist are a dreaded complication of Volkmann's ischemic contracture, postinfective/posttraumatic destruction of the wrist, or tuberculosis of the wrist joint. Most of the times, the patient is advised an amputation with prosthetic replacement as the treated limb also is like a dead limb. To avoid it, a simple alternative is to use the principle of controlled differential fractional distraction histogenesis. Joshi's external stabilization system (JESS) distractors allow gradual distraction of contracted soft tissues and align all the joints of the hand so as to bring corrections of all aspects of hand and wrist deformity simultaneously. This study was done with the aim to analyze the role of differential distraction in correcting cases of flexion contractures of the wrist in terms of cosmetic, functional, and anatomical outcome. Three flexion contractures of the wrist and hand underwent differential fractional distraction. Patients were assessed preoperatively for morphology, functionality, and radiology period of correction varied from 5 to 8 weeks. Once correction was obtained, then apparatus for differential distraction (JESS) is locked in that position for the same period and later converted to plaster cast for maintenance and followed up regularly. Excellent-to-good results were obtained in all the cases as assessed with patient-rated wrist evaluation. There were only minor complications in patients. Differential distraction by JESS frame is a simple, versatile, and cheap method suited for correcting flexion contractures of the wrist and hand, which were neglected and resistant.

Background: A post-burn flexion contracture of the knee joint is a disabling condition which interferes with an upright posture and a bipedal locomotion. Islanded perforator flaps have been used to resurface the tissue defect which is produced as a result of the contracture release. Despite their various advantages, they are limited by an increased tendency to undergo venous congestion. Perforator-plus flaps can be used to overcome this limitation, while retaining the merits of the islanded perforator flaps. Methods: Ninteen patients with post flame burn flexion contrac tures of the knee joints underwent surgical releases and coverages by various local fasciocutaneous perforator-plus flaps. The patients were followed up for 6 months and the various aspects of the functional and the aesthetic rehabilitations were assessed. Results: All the local fasciocutaneous perforator-plus flaps resurfaced the tissue defect over popliteal fossa with good colour and texture match and maintenance of the contour. None of the flaps had any significant early or delayed complications (which included venous congestions) which necessitated reoperations. All the patients were satisfied with the functional and aesthetic outcomes. Conclusion: Local fasciocutaneous perforator-plus flaps can be considered as one of the primary treatment modalities for the surgical release and reconstruction of post burn flexion contractures of the knee.

Post-traumatic or postsurgical flexion contractures of the knee can significantly limit function and lead to gait abnormalities. In this setting, interventions to regain full extension may include bracing, physical therapy, and open or arthroscopic surgery. Open surgical approaches to restore full motion often demand extensive recovery and promote further adhesions and loss of motion, which has led to the advent of arthroscopic techniques to address these pathologies. We present a safe, effective, and reproducible arthroscopic technique for posteromedial capsular release to address knee flexion contractures.

Introduction: Supracondylar fractures of the femur in adults are relatively uncommon and account for only 7% of all femoral fractures 1 . However these fractures are often complex injuries, that present with numerouscomplications, like mal alignment, flexion contractures, stiffness and limb length discrepancies 2 The purpose of this study was to assess the outcome of dynamic condylar screw in supracondylar fractures of femur in adults, while comparing the results with other international studies. Material and methods :. This study was based on 30 patients of fresh supracondylar fractures of the femur treated with dynamic condylar screw at tertiary Trauma Center.. The patients were followed up for 1 year and parameters like union, range of movements and time for healing were recorded. 4 Schatzker and Lambert Criteria (Annexure I) were used to grade the results. Results : The age range was from 18 years to 72 years. 18 patients were male and 12 were female. The cause of injury was high energy trauma like road traffic accidents and fall from height. All fractures were of AO type A. Based on above mentioned criteria, results were excellent in 18 patients (60%), good in 6 patients (20%), fair in 5 patients (17%) and poor in 1 patient (3%). Conclusion : Dynamic condylar screw is one of the best devices to treat supracondylar fractures of the femur.

Background Severe knee flexion contractures greater than 80° are rare and challenging to manage. Previous studies have demonstrated unsatisfactory clinical results after correcting these deformities because residual flexion contractures were not corrected within a short period of time. We herein report the case of a patient with adult-onset Still’s disease with 90° of bilateral knee flexion contracture, which was successfully corrected by total knee arthroplasty and serial casting over a period of five weeks. Case presentation A 47-year-old male was admitted to our orthopedic department for bilateral knee pain and a preoperative fixed flexion contracture of 90°. A diagnosis of adult-onset Still’s disease was made based on the patient’s medical history of a high spiking fever, salmon-colored rash and bilateral knee and wrist pain. Bilateral total knee arthroplasty was carried out to address these deformities, but residual flexion contracture was present. Subsequently, serial casting was used to achieve full extension at four weeks after surgery. Excellent function and patient satisfaction were observed at two years of follow-up. Conclusion The new protocol of total knee arthroplasty with subsequent serial casting seems to be an efficient solution for knee flexion contractures greater than 80°. This report adds to the very small number of reported cases of adult-onset Still’s disease with severe knee flexion contractures and describes a patient who was successfully treated with a new protocol.

Late results of treatment of thermal injury and its sequelae are presented. According the data obtained, the most severe deformities developing after a thermal injury are the flexion contractures of fingers. The results of the study are evidence of a cardinal importance of an appropriate immobilization of the affected segments and of early functional rehabilitation for prevention of contractures development. Without dynamic keeping the children under observation, secondary skeletal deformities develop which are changes in form of bones and their hypoplasia. This enhances the number and volume of reconstructive procedures needed as well as deteriorates the final outcome of the treatment.

Neu–Laxova syndrome (NLS) is an autosomal recessive disorder characterized by central nervous system anomalies, facial dysmorphic features, anomalies of limb and genitalia, intrauterine growth retardation, skin disorders, and other congenital abnormalities. In this article, we present a newborn infant who was born with facial dysmorphic features, flat nose, ichthyosis, rocker bottom feet, and fixed flexion contractures. We believe that these clinical findings in this patient are consistent with features of NLS.

In order to release and cover defects in burn contractures over joints, several surgical procedures have been proposed. Skin grafting is easy to do, but it requires immobilization, and tends to contract again, different types of flaps without skin grafting are alternatives. These flaps have their specific indications, limitations and some disadvantages such as a bulky, unattractive appearance in donor or recipient sites, partial necrosis, and sometimes patients dissatisfaction. Considering these points, the authors proposed a new technique composed of a Y-V advancement in the middle and two scar releases proximal and distal to the joint which were covered with full thickness skin grafts. This seems to have some advantages in both case of technique and more patients satisfaction. In the current study, the authors presented their results with different methods of treatment, which they performed for burn flexion contractures in limbs. Ninety-one operations were performed in 74 patients, the method of reconstruction included skin grafting in 43 contractures, local flaps in 16, pediculated flaps in 11, and the new combined approach in 21 cases. Width of scar was one of the main factors for selection of choice option. This proposed technique is especially appropriate for scars which cover 10-60% of joint surface area. Advantages of this combined technique are coverage of joint area with a pretty normal skin flap, and enough scar lengthening due to combination of Y-V advancement and skin grafted released areas.

Burn contractures of the extremities present a clinical challenge. Flexion contractures are more common than extension contractures. The first component of treatment is adequate contracture release. A number of different methods are available for resurfacing the wound and these are reviewed. An algorithm is presented which permits a simple approach to managing burn scar contracture of the extremities.

Background Burns of the hand cause not only the impairment of hand function but also cosmetic deformity. Cases with dysfunctional hands with severe contractures increase if rehabilitation of the acutely burned hand is not done properly. Purpose We present the use of free dorsoulnar perforator flap in the treatment of postburn contractures as an alternative when local flaps cannot be used. Methods Free dorsoulnar perforator flap was used in the treatment of seven hands with postburn contracture. Five of them had multiple digital postburn flexion contractures. Combined use of cross-finger and side finger transposition flaps was preferred when the adjacent finger was suitable for being cross-finger flap donor. When the adjacent finger was not suitable for being cross-finger flap donor, the free dorsoulnar perforator flap was preferred. Two of the patients had postburn web contractures. Free dorsoulnar perforator flap was used to release the web and to form a new web commissure. Conclusion The free dorsoulnar perforator flap could be a good alternative to cover the defects created with the hand contracture release.