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Treatment of severe iatrogenic quadriceps retraction in children
Gheorghe Burnei1, Petre Neagoe, Bogdam A Margineanu
1Pediatric Surgery and Orthopedics Department, Marie Curie Emergency Pediatric Hospital, Carol Davila Medicine University, Bucharest, Romania.
Insights
Pediatric quadricepsplasty effectively treats severe infantile quadriceps retraction. Both Judet and Payr-Thompson techniques improved knee flexion, with technique selection based on initial range of motion limitations.
Area of Science:
- Pediatric Surgery
- Orthopedic Surgery
- Reconstructive Surgery
Background:
- Severe iatrogenic infantile quadriceps retraction presents a significant surgical challenge.
- Existing surgical techniques for quadricepsplasty include modifications of the Judet and Payr-Thompson procedures.
- Optimal surgical approach selection is crucial for managing this condition in pediatric patients.
Purpose of the Study:
- To assess and compare the outcomes of two distinct quadricepsplasty techniques for severe iatrogenic infantile quadriceps retraction.
- To evaluate the efficacy of modified Judet versus Payr-Thompson techniques based on initial knee range of motion.
- To analyze complication rates associated with each surgical approach.
Main Methods:
- Retrospective analysis of 76 pediatric patients undergoing quadricepsplasty for severe iatrogenic infantile quadriceps retraction.
- Two surgical techniques were employed: modified Judet technique (94 cases) and Payr-Thompson technique (34 cases).
- Patient selection for each technique was based on the initial degree of knee range of motion limitation; follow-up was at least 3 years.
Main Results:
- Both techniques demonstrated significant improvement in maximal knee flexion after 3 years.
- The modified Judet group improved from an average of -3° to 81° flexion.
- The Payr-Thompson group improved from an average of 37° to 115° flexion.
- Frequent complications included skin necrosis with the Judet technique and active extension lag with the Payr-Thompson technique.
Conclusions:
- Both modified Judet and Payr-Thompson quadricepsplasty techniques are effective in treating severe iatrogenic infantile quadriceps retraction.
- Technique selection guided by initial knee range of motion may optimize functional outcomes.
- Awareness of technique-specific complications (skin necrosis for Judet, extension lag for Payr-Thompson) is essential for patient management.
Abstract:
We assessed the results of the treatment of severe iatrogenic infantile quadriceps retraction in a pediatric surgery department, which still admits such cases. We used two different surgical techniques of quadricepsplasty: one based on the Judet technique and the other based on the Payr and Thompson techniques. We selected the technique to perform according to the initial rate of limitation of the range of movement of the knee. We followed 76 patients operated on with one of the two techniques for at least 3 years. There were 94 cases operated on with a modified Judet technique and 34 according to the Payr-Thompson technique. After 3 years, maximal knee flexion improved from an average of -3 to 81 degree in the first group and from 37 to 115 degree in the second group. The most frequent complications were skin necrosis after the Judet quadricepsplasty and active extension lag after the Payr-Thompson procedure.