Surgical Treatment of Extreme Flexion-Abduction Contracture of the Hip Joint and Flexion Contracture of the Knee Joint in Agenesis of Lumbar Spine and Sacrum
ERNST MARQUARDT, MD*
Subtrochanteric amputations are indicated in complete absence of the lumbar spine and the sacrum. Others disarticulate the knee joints to use both tibiae for the stabilization of the spine and to have better sitting in a wheelchair. Limitation in the mobility of the hips may irritate the fusion, especially between the transplants and the pelvis. An alternate surgical procedure involves resection of the femoral head and neck and as much as necessary of the greater trochanter, closure of the bony wound by use of a cartilage-bone-cap of the femoral head later, resection of the distal half of the femur inclusive the condyles and the cartilage of the head of the tibia, fusion of the cartilage-bone-cap of the femoral head with the proximal femoral end, and fusion of the tibia with the distal end of the remaining femur by use of a Rush pin. Between the right and the left side the child should have time for recovery of about 4 weeks. The distal half of both femora will be preserved sterile and deep frozen to be used as transplants for the stabilization of the spine with the pelvis later.
*Orthopedic Hospital of the University of Heidelberg, D-6900 Heidelberg, West Germany