Results of surgical treatment of quadriceps femoris/contracture in children

Background: The child presenting with quadriceps femoris/contracture that is resistant to serial manipulation and plaster casting and the older child with a fixed contracture of the quadriceps is treated surgically at the African Inland Church-Cure International Children’s Hospital. The surgery involves soft tissue release and lengthening of the quadriceps tendon. Open reduction of the knee and femoral osteotomy is done as indicated. Objective: To analyze the outcome of surgical treatment of quadriceps femoris contracture in children. Setting: AIC-CURE International Children’s Hospital in Kijabe, Kenya. Methodology: This is a review of files of children in our hospital treated surgically for quadriceps fibrosis over a period of three years (January 2005 to December 2007). Results: There were fifty one cases of quadriceps fibrosis in thirty six patients treated surgically over the study period. Thirty one cases were excluded due to incomplete records or patients lost to follow-up. Consequently, the remaining twenty cases were analyzed. The pre-operative range of motion of the knee was grouped as follows: two cases had dislocated knees, three had hyperextension contractures, thirteen (0-30 degrees) and two (31-60 degrees). The final post-operative range of motion was grouped as follows: three (0-30 degrees), four (13-60 degrees), three (61-90 degrees), one (91-120 degrees) and nine (full range of flexion). Gain in flexion ranged from minus forty degrees to positive 140 degrees. The average gain in flexion was 94.7 degrees. Five patients underwent a second procedure to improve flexion. Soft tissue complications developed in four cases. Conclusion: Quadriceps femoris/contracture responds well to surgical treatment with an expected gain in flexion of 94.7 degrees. The commonest complication is skin breakdown