Effectiveness of circular hexapod external fixation with soft tissue reconstruction in treating severe knee dislocation
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(2020) 21:639
CASE REPORT
Open Access
Effectiveness of circular hexapod external fixation with soft tissue reconstruction in treating severe knee dislocation due to burn scarring: a case report Koji Nozaka* , Naohisa Miyakoshi, Hidetomo Saito, Hiroaki Kijima, Motoki Mita and Yoichi Shimada
Abstract Background: Severe varus deformity and soft tissue injury caused by a burn around a complex knee dislocation is a rare injury. Soft tissue reconstruction and deformity correction with circular hexapod external fixation of the knee and hinged total knee arthroplasty (TKA) are challenging and can lead to major complications if not performed appropriately. We present a case in which a combination of soft tissue reconstruction, circular hexapod external fixation, and TKA was used treat severe knee dislocation due to burn scarring. Case presentation: We report the case of a 58-year-old woman who presented for knee surgery with soft tissue reconstruction, deformity correction with circular hexapod external fixation, and hinged TKA for a severe complex deformity and soft tissue injury caused by a burn injury at 6 months of age. The left leg was shorter by 35 mm in terms of functional leg length discrepancy. She walked with a limp, with a marked varus deformity of the left knee during the stance phase of walking. After a 3-stage repair, the patient was able to walk without assistance, confirming improvement of mobility. Conclusion: The treatment method was an effective use of a combination of soft tissue reconstruction, circular hexapod external fixation, and rehearsal surgery using a 3D printed bone model of the modular rotating hinge component of TKA, which was successfully used to treat a severe knee dislocation due to burn scarring. This staged surgery maintained the leg length and ultimately achieved a satisfactory alignment. Keywords: Soft tissue reconstruction, Circular hexapod external fixation, Hinged total knee arthroplasty
Background It is challenging to manage a severe complex varus deformity and soft tissue injury caused by a burn around the knee, years after the original injury. This would require several staged treatments with soft tissue reconstruction, deformity correction, and highly constrained or hinged implants. Previously, there have been several reports of arthrodesis with the Ilizarov device after failed knee arthroplasty [1–4]. * Correspondence: [email protected] Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
Additional studies with a larger number of patients with severe injuries such as road traffic accidents, sports injuries, and war trauma around the knee, are needed to confirm the use of circular external fixation as a feasible and effective treatment option [5–8]. The use of circular hexapod external fixation to treat severe knee dislocation due to burn scarring has not been reported previously in the English literature. This method was adopted to overcome the difficulties and avoid the complications associated with
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