الفهرس 
1) Distraction HistogenesisOnly 14 pages are availabe for public view
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Abstract
The knee joint is a synovial joint, the largest joint in the body, it is a modified hinge joint. It is a compound joint that includes two condylar joints between the femur and the tibia and a saddle joint between the patella and the femur.
Knee contractures are one of the most difficult problems causing gait disturbances.
Knee contractures can be congenital, acquired or a combination of the two.
Congenital conditions include:
arthrogryposis, ptrygium- syndrome, meningeomycele/ sacral agenesis and tibial hemimelia.
Acquired conditions are:
neuromuscular disorders, trauma, burns, septic arthritis, juvenile rheumatoid arthritis, haemophilia, poliomyelitis& fibrosis from intra muscular injection.
Combination of congenital and acquired causes such as:
skeletal dysplasia or dwarfism syndrome.
We are focusing on the flexion deformities of the knee as it is more problematic because the centre of gravity permanently falls posterior to the knee and the leg is functionally shortened.
This shortens the stride length and fatigues the extensor mechanism, profoundly disrupting gait mechanism. Flexion deformities can’t be well compensated by the other lower extremity joints or lumbar spine.
Distal femoral or proximal tibial deformities may create or exaggerate a knee flexion deformity.
Children should be considered separately from adults when classifying knees with flexion deformities. Children deformities can recur due to growth or from remodelling of extension osteotomies. On the other hand, adults develop intra-articular fibrosis rabidly, even when contractures are initially extracapsular. These contractures are more resistant to correction by simple soft tissue procedures. The degree of deformity naturally dictates treatment.
knee flexion deformities can be treated nonoperatively (mild deformities of less than 20° of flexion) or by soft tissue releases, extension osteotomies, external fixation, and gradual extension by external fixator (ILIZAROV frame application).
Gradual correction by ILIZAROV technique rather than acute correction by external fixator reduces the risk of neurovascular injury as it is based on the gradual controlled distraction in a predictable manner based upon the biology of distraction histogenesis& osteogenesis.
we are focusing on the treatment of knee flexion deformities by gradual extension by external fixation technique (Ilizarov technique).