THE FIXED FLEXED AND SUBLUXED KNEE IN THE HEMOPHILIC CHILD - WHAT SHOULD BE DONE

Knee haemarthroses are very common in the haemophiliac and often, desp ite infusion of the missing coagulation factor, synovitis develops. Th e warm swollen joint is maintained in the most comfortable position fo r the haemophiliac: flexion. Ambulation is achieved by planterflexion of the ankle joint and toewalking. As the chronic synovitis persists, the range of movement of the knee is affected, with loss of full exten sion. Development of radiological degenerative signs develop. The quad riceps muscle usually weaken due to disuse, but the hamstrings are act ive in maintaining the flexion of the joint. As the process continues, the tibia subluxes posteriorly on the condyles of the femur. The post erior capsule of the knee joint soon contracts, permanently limiting k nee extension. A case is described on whom an Ilizarov device was used to gradually return the limb to a function position. This will allow the patient to complete his growth prior to a definitive orthopaedic p rocedure.