Management of Severe Knee Flexion Contracture of 140° with Fibrous Ankylosis in a Resource-Limited Setting: A Case Report.

Abstract

Background: Chronic knee flexion contracture in children is a rare but disabling condition, particularly in low-resource settings where access to rehabilitation and advanced surgical care is limited.

Case report: We report the case of a 14-year-old boy with an 8-year history of fixed knee flexion contracture following previous knee surgery for infection. The patient presented with inability to walk upright and was forced to crawl for mobility. Clinical and radiographic evaluation confirmed severe contracture and distal femoral deformity. A posterolateral approach with distal femoral osteotomy, acute shortening, soft tissue release, peroneal nerve decompression, rotational skin flap, and gradual distraction osteogenesis using a uniplanar dynamic external fixator was performed. After 5 months, the patient achieved a straight, fused limb, enabling independent upright ambulation.

Conclusion: This case demonstrates that complex knee contractures in resource-limited settings can be successfully managed by distal femur osteotomy, acute shortening, uniplanar dynamic external fixation, and soft tissue reconstruction.