Management of neglected joint contractures.

This review is based on the author's experience treating over 5,000 joint contractures of the lower limbs in developing countries in the tropics and subtropics over the past 40 years. It includes realistic methods of correction of neglected, untreated joint contractures mainly due to poliomyelitis and other paralytic conditions by general duty medical officers. Corrections were performed in centers where medical facilities were often limited and where millions of untreated patients still await treatment. The treatment includes percutaneous correction of flexed hips, knees and equinus ankles and rotational osteotomy of the distal femur for severe knee contractures. Surgery is followed by simple cheap braces made out of local materials. These methods will usually allow early mobility, and in severe cases survival instead of early death.