During a 6 cm tibial lengthening with an Ilizarov frame, a 16-year-old boy develops a progressively worsening plantarflexion contracture of the ankle that is not responding to physiotherapy and night splinting. What is the next best step?

• A Continue lengthening unchanged and reassess after completion
• B Stop distraction permanently and consolidate the regenerate
• C Percutaneous gastrosoleus or Achilles tendon lengthening ✓
• D Plan a corrective ankle arthrodesis at frame removal

Explanation

Equinus is the most common joint contracture during tibial lengthening because the gastrocnemius spans both the knee and the ankle and is stretched by every millimetre of distraction. When serial stretching and splinting fail, surgical lengthening of the gastrosoleus complex prevents a fixed equinus and the rocker-bottom gait that follows. Stopping lengthening does not reverse an established contracture.

Reference: Chapman's Orthopaedic Surgery, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.