[The effect of children's gluteal muscle contracture on skeleton development]

OBJECTIVE

To explore the effect of children's gluteal muscle contracture (GMC) on skeleton development.

METHODS

The pelvic plain films of 368 GMC cases confirmed by operation from May 1995 to June 2005 and those of 200 individuals as control were analyzed for this research project. The pelvic CT scans were performed in 30 GMC cases and 25 controls. The data of both groups were used to comparison, analysis and statistics treatment in pelvic plain X-ray film, hip joint, acetabular index, neck shaft angle, centre-edge (CE) angle, the form of pelvic obturator foramen, the existence or nonexistence of the iliac hyperdense line.

RESULTS

There were 68 cases with pelvis obliquity in the case group but no one in the control group. The iliac hyperdense lines at the side of sacroiliac joints were found on the pelvic plain films of 321 of 368 cases with GMC and 5 of 200 controls. In 368 cases with GMC, the iliac hyperdense lines were detected in 306 of 314 patients beyond 7-year-old, and 313 of 336 appeared mostly the contracture of gluteus maximus muscle, which showed to be significant in statistics. In GMC group, the oblique plane became steeper and almost oriented posteroanteriorly, while in control group,the pelvic CT showed that the outer codex of posterior ilium at the level of sacroiliac joint appeared as an oblique plane, oriented from posteromedial to anterolateral side. The data were processed with statistics software, found that compared with the control group, the results of pre-operation group's examines such as CE angle, neck shaft angle, longitudinal diameter, cross diameter, and the iliac hyperdense line had significant differences (P < 0.01), the results of post-operation group's those examines showed no significant differences (P > 0.01), and the acetabular index appeared no significant differences (P > 0.01).

CONCLUSION

The children's gluteal muscle contracture has the significant effect on skeleton development, which could lead to pelvis obliquity, coxa valga, leg length pseudoinequality, CE angle increasing, etc. The iliac hyperdense line on the pelvic plain film is probably a characteristic change of GMC.

Use of an in vitro model of tissue-engineered skin to investigate the mechanism of skin graft contraction

Skin graft contraction leading to loss of joint mobility and cosmetic deformity remains a major clinical problem. In this study we used a tissue-engineered model of human skin, based on sterilized human adult dermis seeded with keratinocytes and fibroblasts, which contracts by up to 60% over 28 days in vitro, as a model to investigate the mechanism of skin contraction. Pharmacologic agents modifying collagen synthesis, degradation, and cross-linking were examined for their effect on contraction. Collagen synthesis and degradation were determined using immunoassay techniques. The results show that skin contraction was not dependent on inhibition of collagen synthesis or stimulation of collagen degradation, but was related to collagen remodelling. Thus, reducing dermal pliability with glutaraldehyde inhibited the ability of cells to contract the dermis. So did inhibition of matrix metalloproteinases and inhibition of lysyl oxidase-mediated collagen cross-linking, but not transglutaminase-mediated cross-linking. In summary, this in vitro model of human skin has allowed us to identify specific cross-linking pathways as possible pharmacologic targets for prevention of graft contracture in vivo.

A computer-controlled contracture correction device with low-load and continuous torque: an animal experiment and prototype design for clinical use

The purpose of this study was to clarify the relationship between mechanical stress and tissue response of the contracted knee joint in rats and to propose a new design of contracture correction device for clinical use. Wistar rats were operated on to immobilize their knee joints with a procedure causing periarticular bleeding and were kept in flexed position for 40 days. At day 40, the immobilizing wire was removed, and after day 43, the contracted knee joint had been treated with tunable corrective devices secured by an external fixation method to the rear limb. These devices consisted of four types of motor-driving system which provided several different low-load and continuous stretch torques. Measuring the angle of maximum knee extension, its effectiveness was assessed comparing with a lower load and control group of natural recovery course. The device also had a cyclic joint movement within the acquired range of motion and an oval cam mechanism producing a small distraction force to the joint along its long axis. The results showed that an appropriate range of low-load continuous torque was more effective to correct joint contracture. On the basis of the animal experiment, a new computer-controlled, gas-driven contracture correction device was developed for clinical trial. It was concluded that mechanical application in a condition with low and continuous torque is a useful treatment for fixed joint contracture.

The role of isolated gastrocnemius and combined Achilles contractures in the flatfoot

In the absence of bony deformity, ankle equinus is generally the result of shortening within the gastrocnemius-soleus complex. Restriction of ankle dorsiflexion as a proxy for equinus contracture has been linked to increased mechanical strains and resultant foot and ankle pathology for a long time. This entity has many known causes, and data suggest it can manifest as either an isolated gastrocnemius or combined (Achilles) contracture. Numerous disorders of the foot and ankle have been linked with such "equinus disease", and although some of these relationships remain controversial, a reasonably convincing relationship between equinus contracture and the development of flatfoot exists. What is still perhaps most misunderstood is the temporal association between these two pathologies, and hence higher levels of evidence are needed in the future to define more precisely the interplay between flatfoot deformity and gastrocnemius-soleus tightness.

Joint distraction and reconstruction in complex knee contractures

We retrospectively reviewed the results of joint distraction and reconstruction in complex knee contractures in 6 patients with 9 knees. The circular Ilizarov fixator was used in all cases. Extensor mechanism alignment with frame in situ was performed in 4 cases and alignment of mechanical axis of the lower limb was done in 2. All patients had a mean total arc of movement of 79 degrees before operation; however, this was nonfunctional because of the degree of flexion contracture. Three of the 6 patients were nonambulant before surgery. After joint distraction and reconstruction, mean total arc of movement remained unchanged, but this was more functional with improvement in the mobility status. At an average follow-up of 53 months, the mean flexion contracture was 100 degrees (range, 0-70 degrees), with further flexion possible up to 90 degrees (range, 60-120 degrees). Four patients had no recurrence. All 6 patients were ambulant with or without orthosis. Rebound phenomenon with loss of achieved correction was observed in 2 patients. Four patients were quite satisfied with results of surgery. Realignment of the extensor mechanism and mechanical axis is an important part that needs to be addressed in flexion contractures of the knee. Proper preoperative planning and staged procedures reduce the risk of recurrence. A treatment protocol is proposed to help in planning and further management.

Effects of physical therapy in the treatment of the posttraumatic elbow contractures in the children

Pediatric post-traumatic elbow contracture can occur as result of the various injuries of area of the elbow joint. The aim of the study was to investigate the effect of the physical therapy and rehabilitation on the range of the motion of the elbow joint in the post-traumatic elbow contractures in the childhood. We analyzed in this research 54 children (average age 9,4+/-3,15 years) that were treated because of posttraumatic elbow contractures. Kinesitherapy, occupational therapy and other procedures physical therapy are used in the management. Range of the motion of the elbow was measured at the beginning and the end of the therapy for every child. Functional outcome was presented in degree from 1 to 3 (Flynn). Satisfied result of the therapy at the discharge was in the 94, 45% of the children and 74, 07 % of the children had excellent result The difference in the grade at the beginning and the end of the therapy is statistically significant (t= 13,72, p<0,001). Significant improvement of the range of the motion in the elbow joint in the children with post-traumatic elbow contracture is attained by physical therapy.

The rotator interval: anatomy, pathology, and strategies for treatment

Over the past two decades, it has become accepted that the rotator interval is a distinct anatomic entity that plays an important role in affecting the proper function of the glenohumeral joint. The rotator interval is an anatomic region in the anterosuperior aspect of the glenohumeral joint that represents a complex interaction of the fibers of the coracohumeral ligament, the superior glenohumeral ligament, the glenohumeral joint capsule, and the supraspinatus and subscapularis tendons. As basic science and clinical studies continue to elucidate the precise role of the rotator interval, understanding of and therapeutic interventions for rotator interval pathology also continue to evolve. Lesions of the rotator interval may result in glenohumeral joint contractures, shoulder instability, or in lesions to the long head of the biceps tendon. Long-term clinical trials may clarify the results of current surgical interventions and further enhance understanding of the rotator interval.

[Clinical application of groin skin and iliac bone composite graft in contracture of first web space and reconstruction of pollicis opponens function]

OBJECTIVE

To investigate the therapeutic effects of the groin skin and iliac bone composite graft on the repair of severe contracture of the first web space and one-stage reconstruction of the pollicis opponens function under the condition of no ideal muscle or tendon used.

METHODS

From July 2003 to February 2006, 5 patients (4 males, 1 females; age range, 20-38 years) with severe contracture of the first web space with loss of the pollicis opponens function were treated by the groin skin and iliac bone composite graft, with the clinical observation performed. The defect was caused by a crush injury in 3 patients, by an explosion injury in 1 patient, and by a wrist joint mutilation injury in 1 patient. They all had been treated by operation at least once with a disease course of 6-24 months. The width and the angle of the first web space was 18 mm and 20 degrees on average.

RESULTS

The followed-up for 6-12 moths revealed that all the flaps had a success. The pedicle of the groin skin and iliac bone composite graft was cut off after 3 weeks, and 8 weeks later there was a bone union between the imbedded bone block and the first and second metacarpal bones. There was no evidence that the imbedded bone block was deformed or absorbed. The width of the first web space was augmented by an average of 32 mm, the angle of the first web space was augmented by an average of 60 degrees. The pollicis opponens function recovered.

CONCLUSION

It is relatively simple and reliable to repair the contracture of the first web space and reconstruct the pollicis opponens function in one-stage using the groin skin and iliac bone composite graft.

The Mechanics Behind the Image: Foot and Ankle Pathology Associated with Gastrocnemius Contracture

Contracture of the gastrocnemius musculature is a prevalent finding in the setting of foot and ankle pathology. Tightness of the posterior musculotendinous structures in the leg limits ankle range of motion and affects an equinus posture of the foot. Increased contact pressures are generated in the plantar foot with weightbearing. The resultant overload of the ligaments and the intrinsic muscles of the midfoot and forefoot is manifest in a variety of pathologic processes. The altered mechanics contributes to, among other conditions, ankle impingement, plantar fasciitis, midfoot arthritis, posterior tibial tendon dysfunction, forefoot overload, diabetic ulceration, and Charcot arthropathy. Effective management of these conditions includes addressing the underlying gastrocnemius contracture as well as the related foot and ankle pathology. Here we describe the underlying biomechanical abnormalities and radiographic findings in these pathological conditions of the foot and ankle associated with gastroequinus contracture. An awareness and understanding of the pathomechanics should enable the radiologist to better appreciate the form and function associated with the image.

A method to evaluate contractures effects during the gait of children with Duchenne dystrophy

Joint contractures are the second major impairment affecting the locomotor system of children with Duchenne muscular dystrophy (DMD). While the negative influence of joint contractures has been documented, the passive moments produced by joint contractures could benefit the gait of patients with muscle weakness. We describe a biomechanical model that quantifies the mechanical contribution of ankle and hip flexion contractures to the gait of DMD children. Kinematic and kinetic parameters were measured under the same experimental conditions during the gait and passive resistance assessment of two subjects: one healthy child as a control, and one child with DMD. The child with DMD had a plantar flexion contracture and a greater ankle stiffness coefficient than the control child. During gait, the contribution of the ankle passive moment to the net moment was more important for the child with DMD than for the control child. At the hip, passive joint moments and passive moment contribution were more important for the control child but this was not related to the presence of hip flexion contracture. These preliminary results suggest the model might be used to evaluate contractures effect on a larger cohort of subjects.

A torque-controlled device to measure passive abduction of the thumb carpometacarpal joint

The primary aim of this study was to design and then test the intrarater reliability of a torque-controlled method of measuring passive abduction of the thumb carpometacarpal (CMC) joint. A secondary aim was to quantify passive CMC abduction in patients with and without contracture. Initially, clinicians used subjective feel (without range of motion measurements) to identify 52 people with loss of passive thumb CMC abduction. All subjects had a neurological condition. Passive thumb CMC abduction was measured in both hands of these 52 people and the hands of another 20 healthy able-bodied individuals (total of 72 people and 144 hands). Passive thumb CMC abduction was measured using a newly designed torque-controlled device and the previously recommended caliper method. Repeat measurements were taken with both devices, two to three days later, by blinded assessors on a subgroup of 12 patients (24 hands). Median (interquartile range) CMC angle of thumbs deemed by clinicians to have contracture was 45 degrees (41-52 degrees) and that of subjects without contractures was 56 degrees (53-60 degrees). The intraclass correlation coefficient for the repeat measures attained with the torque-controlled device was 0.78 (95% confidence interval, 0.56-0.90). The torque-controlled device provides a way of standardizing torque when measuring passive thumb CMC abduction. The clear difference between passive CMC abduction of subjects with and without contracture confirms the ability of clinicians to use feel and subjective assessment to identify patients with contracture.

Multiple-loop, uniform-tension flexor pulley reconstruction

A technique of pulley reconstruction using multiple loops of gracilis allograft tendon with uniform tension through all the loops is described.

Effects of Splinting on Wrist Contracture After Stroke

BACKGROUND AND PURPOSE

Splints are commonly applied to the wrist and hand to prevent and treat contracture after stroke. However, there have been few randomized trials of this intervention. We sought to determine whether wearing a hand splint, which positions the wrist in either a neutral or an extended position, reduces wrist contracture in adults with hemiplegia after stroke.

METHODS

Sixty-three adults who had experienced a stroke within the preceding 8 weeks participated. They were randomized to either a control group (routine therapy) or 1 of 2 intervention groups (routine therapy plus splint in either a neutral or an extended wrist position). Splints were worn overnight for, on average, between 9 and 12 hours, for 4 weeks. The primary outcome, measured by a blinded assessor, was extensibility of the wrist and long finger flexor muscles (angle of wrist extension at a standardized torque).

RESULTS

Neither splint appreciably increased extensibility of the wrist and long finger flexor muscles. After 4 weeks, the effect of neutral wrist splinting was to increase wrist extensibility by a mean of 1.4 degrees (95% CI, -5.4 degrees to 8.2 degrees), and splinting the wrist in extension reduced wrist extensibility by a mean of 1.3 degrees (95% CI, -4.9 degrees to 2.4 degrees) compared with the control condition.

CONCLUSIONS

Splinting the wrist in either the neutral or extended wrist position for 4 weeks did not reduce wrist contracture after stroke. These findings suggest that the practice of routine wrist splinting soon after stroke should be discontinued.

[Reconstructive operations for scarry contractures of the shoulder joint after burns]

The article presents two methods of formation of the axilla cupola with saved skin from the area of hair growth, and when there are scarry changes. The first method allows exclusion of displacement of the axilla skin into not proper places. The second method gives better engraftment and better outcomes of operation. A method of two-stage treatment was worked out for severe contractures of the shoulder joint in order to avoid a transection of the tendons and muscles and overdistention of the vascular-nervous bundles. During the preoperative period a gradual liberation of the shoulder is to be fulfilled by means of a dosated distraction of the scars, contracted tendons and muscles. The dosated distraction is performed using a specially developed splint with a turnbuckle mechanism. Using the splint the full volume of movements was restored in 73.9% of the patients. In the rest of the cases operative treatment was used, and the distracted scarry tissues can be used as plasty material.

The stiff elbow

Etiologies of elbow contractures can be classified into intrinsic versus extrinsic causes. Posttraumatic elbow stiffness is the most common intrinsic cause and HO formation is the most common extrinsic cause of elbow contractures. Patients who sustain significant elbow trauma and have one or more risk factors for HO formation should be given prophylaxis against HO formation in the form of either indomethacin or radiation therapy. Early excision of HO has been shown to be safe and effective. Nonoperative measures are most effective if used within 6 months of contracture onset. These measures include physical therapy and an aggressive splinting program. If nonoperative measures are unsuccessful and the patient has functionally limiting elbow ROM, then surgical intervention should be considered. Careful preoperative assessment of the ulnar nerve is mandatory, as it may need to be transposed. Satisfactory results have been reported with arthroscopic elbow contracture releases. However, this procedure is technically challenging, with the potential for serious neurovascular complications. Satisfactory results have been published for open procedures as well. The direction of the greatest limitation of motion, the presence of ulnar nerve dysfunction, and the location of osteophytes all help to dictate which surgical approach should be selected.

Managing the stiff elbow: operative, nonoperative, and postoperative techniques

Elbow contracture may be caused by intrinsic or extrinsic limitations or a combination of both. Evaluation of the specific structures guides the development of an effective therapy treatment program. Intrinsic contractures are by definition due to joint/intra-articular incongruency, and therefore therapy and splinting cannot provide increase in joint motion. Nonoperative therapy treatment options include heat modalities, myofascial soft tissue mobilization, joint mobilization, muscle energy techniques, passive range of motion, active range of motion, extensive use of corrective splinting, and strengthening exercise. All operative candidates must participate in a preoperative therapy program of six to eight weeks to reduce extrinsic contractures as feasible and to assess patient compliance with an intensive postoperative therapy program. Corrective splinting may be needed for as long as six months to maintain gains made in surgery. The therapy following manipulation under anesthesia and open contracture release is similar. The therapist must know the details of the procedure. Operative treatment for the stiff elbow progresses in a sequential fashion to progressively release tissue structures limiting motion and reconstruct any structures as needed to provide joint stability. Postoperative therapy consists of continuous passive motion , corrective splinting, modalities, and specific exercise techniques to maintain passive gains achieved in surgery. The therapy is extensive and requires full participation from the patient to maximize motion and function. Complications of elbow contracture release include nerve palsy or nerve injury, seroma, joint instability, heterotopic ossification, and recurrence of elbow contracture.

The use of external skeletal fixation to facilitate the surgical release of wrist flexion and thumb web space contractures

PURPOSE

To evaluate the use of external fixation as a splint to keep the hand in the desired position after simultaneous joint and soft-tissue release in a single stage for treatment of first web space and wrist contractures.

METHODS

Six first web space adduction and 7 wrist flexion contractures were released surgically. All patients had prior unsuccessful surgery. After surgical release of the contracture and capsulotomy, external fixator pins were inserted into the first and second metacarpals to maintain thumb abduction and into the radius and second metacarpal to maintain wrist extension, followed by skin grafting. External fixation was followed by splinting. Results were based on persistence of contracture release, rate of complications, and functional outcome.

RESULTS

Before surgery, the thumbs were contracted at an average of 0 degrees of adduction with no range of motion, and wrists were contracted between 85 degrees to 100 degrees of flexion. The duration of contracture and number of prior surgeries did not influence the amount of release obtained during the surgery. After 7 months to 7 years of follow-up of first web space contractures, the thumb was in an average of 55 degrees of palmar abduction. Patients were able to oppose and fully adduct. At long-term follow-up examinations of the wrist contractures, patients had the wrist in the neutral position (0 degrees) in the resting state, with active extension ranging between 5 degrees and 15 degrees and flexion ranging between 35 degrees and 45 degrees . In 1 patient the wrist was at 45 degrees of flexion in the resting state with an arc of motion of 20 degrees . In 1 patient the wrist contracted back to the preoperative position, requiring another surgery. All patients experienced increased activity and improvement in grasping objects at 6-month follow-up evaluations. Complications included 3 pin site infections, 1 severe discomfort after 6 weeks, and 1 median nerve compression. All were treated successfully.

CONCLUSIONS

External fixation can be used to maintain position in cases of first web space and wrist flexion contractures after surgical release, especially in patients for whom standard methods have failed. It is safe, efficacious, and well tolerated.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Fractional flexor tendon lengthening for advanced metacarpophalangeal flexion contracture in rheumatoid hands

This technical report discusses a subgroup of rheumatoid patients who have minimal ulnar drift but a severe fixed metacarpophalangeal joint flexion contracture for whom conventional metacarpophalangeal joint arthroplasty alone was insufficient to correct the deformity. We describe a surgical technique to deal with this clinical problem that uses fractional flexor tendon lengthening in the forearm to correct the severe flexion deformity at the metacarpophalangeal joint.

Uses of scapular island flap in pediatric axillary burn conractures

Pediatric axillary post-burn contractures one of the most challenging problems which follow treatment of the upper extremity burns. We preferred to use scapular flaps for surgical treatment of pediatric axillary contractures instead of skin grafting or Z-plasties. In this clinical study we present 13 pediatric cases treated with scapular island flaps. In pediatric scapular flap cases, the technique which we used was to extend the flap's pedicle dissection was continued to the level of bifurcation of subscapular artery. Bypassing the flap triangular space allowed us to cover the anterior part of the axillary contractures. We observed that the scapular flap repairs have many benefits to skin grafting including no recurrence of contracture and stable coverage of the shoulder joint. The other advantages of scapular island flap are that the donor site is closed primarily, and it provides an adequate amount of pliable skin while not compromising the function and range of motion of joints. In conclusion, the island scapular flap is a good choice for reconstruction of various axillary contractures in pediatric population.

Outcome of open release for post-traumatic elbow stiffness

BACKGROUND

Post-traumatic elbow stiffness can be caused by a tether and/or a block, and these structures can exist both anteriorly and posteriorly about the joint to prevent motion. The purpose of this article is to report the outcome of elbow release performed for post-traumatic stiffness by a single surgeon.

METHODS

A retrospective review of charts and radiographs was performed on 52 case of patients who underwent open surgical treatment for post-traumatic elbow contracture by the senior author (RHN). The mean age of the group was 35.1 years. There were 32 men and 20 women. Contracture release surgery was performed at an average of 14 months from the time of injury. Indication for operative release was functional loss of elbow arc of motion that failed nonoperative therapy and splinting program. Follow-up was 18.7 months. Comparison of ranges of motion was performed with Student's paired t tests.

RESULTS

The average extension-flexion arc of motion improved from 57 to 116 degrees and forearm rotation improved from 119 to 145 degrees postoperatively. Fourteen patients (27%) required closed manipulation under anesthesia, in the early postoperative period. Five patients required a second contracture release at an average of 12 months after the index release. Four patients failed because of painful motion (n = 2) and elbow instability (n = 2). Other complications included wound infection (n = 3), cubital tunnel syndrome (n = 3) and reflex sympathetic dystrophy (n = 1).

CONCLUSIONS

Open elbow release with excision of tethers and blocks is a valuable procedure for post-traumatic stiffness. Recurrence in postoperative period is common but is responsive to manipulation under anesthesia and repeat releases.

The use of combined lateral and medial releases in the treatment of post-traumatic contracture of the elbow

Elbow stiffness is a common disorder, which restricts daily activities. Between 30 degrees and 130 degrees of elbow movement is usually enough to perform most daily activities. However, a 10 degrees to 15 degrees loss of elbow extension may be a problem when the patient is an athlete. From 1996 to 2004, 20 elbows of 20 patients (who were available for follow-up examination) were treated by lateral and medial release at Kocaeli University, for post-traumatic elbow contracture. Preoperative and the postoperative 12-month follow-up measurements were performed. The mean preoperative arc of motion was 35 degrees and this value improved to 86.2 degrees . The maximum improvement at the arc of motion was 105 degrees . In an effort to understand the pathophysiology of the condition, surgical approaches may be used safely. The purpose of this study was to assess the functional outcome of the elbow joint after using a combination of lateral and medial approaches to treat elbow stiffness.

Elbow capsulectomy for posttraumatic elbow stiffness

PURPOSE

To determine factors associated with diminished elbow function and upper-extremity-specific health status after elbow capsulectomy for posttraumatic stiffness.

METHODS

Forty-six adult patients with posttraumatic elbow stiffness were evaluated an average of 48 months after open capsular excision. A second capsular excision was performed in 9 patients (29%). Stepwise multiple linear regression analysis was used to identify predictors of the American Shoulder and Elbow Surgeons Elbow Score, the Mayo Elbow Performance Index, and the Disabilities of the Arm, Shoulder, and Hand scores after all procedures.

RESULTS

The average improvement in ulnohumeral motion after the index surgery for capsular release was 53 degrees . (The average flexion was 98 degrees .) The 9 patients who had subsequent repeat elbow contracture release gained an additional 24 degrees , leading to a final average flexion arc for the entire cohort of 103 degrees . Multiple linear regression identified the American Shoulder and Elbow Surgeons pain score, persistent ulnar nerve dysfunction, and duration of follow-up evaluation after the initial capsular release as independent predictors of a higher Disabilities of the Arm, Shoulder, and Hand questionnaire score; flexion arc and pain score as independent predictors of the Mayo Elbow Performance Index; and flexion arc, forearm arc, pain score, and persistent ulnar neuropathy as independent predictors of the American Shoulder and Elbow Surgeons score.

CONCLUSIONS

Open elbow capsulectomy for posttraumatic elbow stiffness restores a near-100 degrees flexion arc on average. Second elbow releases provide limited additional motion in most patients. Final motion influences physician-based rating scales but not patient-specific health status (Disabilities of the Arm, Shoulder, and Hand questionnaire), which is dominated by pain and persistent ulnar neuropathy.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Soft tissue knee contracture of the knee due to melorheostosis, treated by total knee arthroplasty

Melorheostosis is a rare condition which can cause soft tissue joint contractures. We present a case of melorheostosis causing disabling knee joint contracture, treated successfully by total knee arthroplasty.