A modified Thompson quadricepsplasty for extension contracture resulting from femoral and periarticular knee fractures.

BACKGROUND The lack of knee flexion is an increasingly recognized complication of femoral and periarticular knee fractures. This is a significant challenge for both surgeon and patients. METHODS This article reports the clinical outcomes of 40 knees in 40 patients who underwent a modified Thompson quadricepsplasty. They were 36 men and 4 women. We performed a modified Thompson quadricepsplasty for all patients without excision of vastus intermedius even in scarred cases. The definitive flexion gain was classified recording to Judet criteria; excellent defined as >100 degrees, good when >80 degrees and <99 degrees, fair when >50 degrees and <79 degrees, and poor when <50 degrees. RESULTS Patients were operated on average 6.9 months +/- 3.6 months (range, 4-24 months) after first initial surgery. Average follow-up was 17.5 months (range, 12-24 months). According to Judet criteria, 9 patients (22.5%) achieved excellent, 27 patients (67.5%) good, 2 patients (5%) fair, and 2 patients (5%) poor. Final average flexion arc improvement was 65 degrees +/- 25.99 degrees with a range between 5 degrees and 100 degrees. Our complications included two cases (5%) of superficial infection and one case (2.5%) with patellar fracture. In patients who had preoperative extension lag, we did not achieve a significant improvement of the extension lag (p = 0.062). CONCLUSION Modified Thompson quadricepsplasty is a promising procedure with satisfactory results. It provides significantly results if it is performed earlier and in more severe extension contracture.