Correction of severe knee flexion deformity conservatively in patients with postpolio residual paralysis by turnbuckle distractor: A report of two cases

Abstract

In postpolio residual paralysis (PPRP), fixed flexion deformity (FFD) at the knee is commonly encountered. Severe knee FFD is usually corrected by surgical interventions. We studied two cases of PPRP with severe right knee FFD. In the first case, FFD was partially corrected by surgery, and subsequent serial wedge plaster-of-Paris casting had a negligible effect. In the second case, no surgery was performed. Instead, we used a simple, locally made turnbuckle distractor, which works on a corkscrew mechanism, to correct knee FFD. In both cases, the desired correction was achieved after 10 and 14 weeks of distractor application, respectively. The turnbuckle distractor is a cheap and excellent noninvasive tool for correcting severe knee FFD in PPRP, even avoiding the need for surgery. It also facilitates gradual stretching of the neurovascular bundle and muscle tendons, without causing neurovascular deficits or complications. This distractor can be considered a first-line option for FFD, especially in areas where surgical facilities are not available.