Purpose: Arthrogryposis is a disease of muscular system, which is characterized by fibrous degeneration of muscles that leads to deformed and rigid joints. Aim of this study is to describe the deformities of the lower limbs and their surgical treatment.

Material – Methods: Twenty children (12 boys-8 girls) with distal arthrogyposis were treated in our department during the decade 1992–2002. The deformities of lower extremities were referred to hip, knee and foot. Congenital dislocation of hip joint was noticed in 4 patients that were treated by open reduction, while fixed flexion and adduction deformity was appeared in 8 patients that were treated by release of flexors and adductors muscles of hip. The main deformity in knee was fixed flexion deformity (19 patients), while hyperextension was presented only in one patient. The flexed knee was corrected with release or lengthening of hamstrings. The most frequent foot deformities were equinovarus deformity (17 patients) and fixed flexion deformity of toes (15 patients). Club foot was treated by posteromedial capsulectomy, lengthening of Achilles tendon, release of posterior tibialis and transfer of anterior tibialis in the lateral aspect of foot, while fixed flexion deformity of toes were corrected by release of flexor longus digitorum and palmar aponeurosis.

Results: All patients had postoperative correction of the deformities. Recurrence of the deformities was noticed in all patients after two years. Fifteen patients were re-operated 4 years after the first surgical treatment.

Conclusion: High degree of recurrent deformities of lower limbs is appeared after their surgical treatment, but this treatment is the only one for patients with distal arthrogryposis in order to succeed independent ambulation.

In this report we present the results of the primary suture of the flexor tendons in zone II, in 198 patients who were operated in our department between 1998 and the first months of 2001. 142 were male from 16 to 65 years old and 56 were female between 14 to 60 years old. Children below 14 years old are not included in this report.

The majority of patients in this review reported an accident during dancing and late night activities. Patients with complex injuries such as fractures of phalanges, phalangeal dislocations and extensive soft tissue laceration were excluded. The majority of the patients operated immediately within the first 48 hours and only 28 patients (14, 5%) were operated with a delay ranging between 1 – 5 weeks. The suturing technique was variable in all cases. A Bruner (zig-zag) incision was utilized to facilitate. The tendon was sutured using a standard Kleinert technique and 4.0 nylon sutures as supportive sutures, 5.0 nylon sutures were used to suture the epitendon in a continuous fashion. A dorsal splint holding the wrist in 40° of flexion and the MP joints in 70° of flexion and PIPs and DIPs in extension was used postoperatively. Early mobilization was initiated (shortly after surgery, 3 – 4 days) and lasted 4 weeks. After this period the patient underwent a program of full active motion for an additional 4 weeks. They finally allowed to perform freely after a 12-week postoperative period.

We used the Kleinert score to evaluate the surgical results. According to this score results were found to be: Excellent in 80 patients (40%), good in 60 pts (30%), fair in 22 (12%) and poor in 16 pts (8%). Despite the satisfactory overall results we observed a high incidence of tendon ruptures (10%) in 20 patients and this may be related to poor follow up and rehabilitation conditions. No other complications (infection, hematoma formation, and skin slough) were observed in these patients.