Modified Judet's quadricepsplasty plus patellar traction for knee stiffness after femoral fracture surgery.

ABSTRACT

BACKGROUND: To investigate the clinical effect of modified Judet quadricepsplasty (MJ) combined with patella traction designed by ourselves in the treatment of knee joint rigidity after a femoral fracture. METHODS: We retrospectively reviewed the clinical data of 21 patients with stiff knee joint after a femoral fracture treated by modified Judet quadricepsplasty combined with patella traction designed by the author from May 2014 to January 2017. The age at revision surgery was 20-57 (36 ± 12) years. The time between fracture fixation to quadricepsplasty was five to 23 (15 ± 5) months, and the follow-up was 11-32 (18 ± 6) months. Pre-operative, intra-operative, post-operative and final follow-up range of motion (ROM), the total traction time, and complications were assessed. The knee joint function was evaluated according to Judet's classification scheme. RESULTS: Knee ROM was 5-60 (36 ± 13) ° pre-operatively, and 30-80 (53 ± 13) ° after MJ (an increase of 0-30 (17 ± 10)) (p < 0.05). The duration of patellar traction was ten to 14 (11 ± 2) days. Knee ROM after traction device removal was 90-100 (92 ± 3) °, an increase of 10-65 (39-14) ° compared with the ROM after arthrolysis (p < 0.05). The follow-up duration was 11-32 (18 ± 6) months. Knee ROM at final follow-up was 80-130 (104 ± 12) °, an increase of 40-100 (68 ± 16) 8° compared with pre-operatively (p < 0.05), and of - 10-40 (12 ± 13) ° compared with the ROM after traction removal (p < 0.05). Knee function was excellent in 14 cases (67%), good in 6 (28%), and fair in one (5%). CONCLUSIONS: The MJ plus patellar traction lengthens the contracted quadriceps femoris, thus restoring knee function within a short period of time.