Congenital knee dislocation{CDK}

fig.1

fig.1a

Congenital knee dislocation is a very rare deformity, its incidence is 0,017 per 1000 live births {Jacobsen and Vopalecky , 1985} According to our data, 30 to 40 children with CDK are born in Russia every year.

The beginning of treatment is usually conservative - manual correction, splinting or Plaster-of-Paris immobilization. If unsuccessful, since age of 3 months surgery is indicated. For the last 15 years we were working on improvement of early conservative treatment technique. Today our experience is considered to be one of the most successful in the world. Our methods were presented during the First International Congress of Pediatric Orthopedic Societies {Sendai, Japan, 2001}. Since then 2 years passed, and we have achieved a 5-day correction period of CDK and excluded circular plaster immobilization. Therefore, the whole treatment procedure was taking place in maternity hospital. Neither of our patients needed surgical treatment.

fig.2

fig.3

Our article concerning CDK will be published in JPO as soon as possible.
Meanwhile we would like to present an interesting case of severe CDK.
Patient A. {fig.1, 1a} was born in one of the maternity hospitals in St.Petersburg on January 30-th, at 3:00 p.m. with CDK. Therefore, an orthopedists was urgently called. The specialist after evaluating the case considered it to be severe: complete dislocation, range of motion from 90 degrees retroflexion to 10 degrees of correct flexion. Treatment was started on the first day of life - a von Rosen splint was applied {fig.2}. Hyperextended knees were moved into correct position twice a day for 5 to 10 degrees each time. Knee flexion up to the right angle was achieved during the 4 days, and Plaster-of-Paris splints ware applied for a period of 5 days.
After that,the knee motion was 180/70 {fig.2, 3}, and baby was discharged from the maternity hospital.

fig.4

No additional plaster fixation was needed .The baby was examined by 5 different orthopedic surgeons at the age of 3 months, and there was no notification of any knee abnormalities.