Jafar R., 14

Jafar is a 14 year old male child currently staying with his parents and siblings. He attends a government school. He is known by all to be very intelligent and is one of the best in his class. Jafar wishes to become an engineer. He is also good in sports even with his current condition. The father is aged and currently not working. They live in a 2 rooms apartment, pit toilet, having a well but no access to electricity. Family monthly income is 15000. Ja’afar sustained injury to his left knee while playing three years ago and he was managed by a traditional healer, the site got infected and started draining pus around his knee leading to ulceration. When the wound healed, his leg was attached to the thigh, since then he has not been able to walk with the affected leg. There is severe contracture of the left knee at the popliteal region. The muscles of the leg and thigh have atrophied and shortened but the knee joint is pliable. Unstable scar noted at the popliteal fossa and medial as well as lateral aspect of the thigh/knee. He was diagnosed with Severe Post-Infective Left Knee Contracture .

Ja'afar presented with four years history of left knee deformity following minor trauma to the same limb. Due to poverty lack of information, he was taken to a traditional healer who tied the limb which later got infected. The infection spread to involve the thigh and leg. On healing the thigh and leg were glued together making him unable to walk. He presented in this situation in our facility where he was treated surgically. The contracture was released completely, the open wound was then closed with split thickness skin graft. Within 5 days Ja'afar was able to walk again. The knee was fully extended and could bear his weight. He was discharged home fifteen days after the surgery to continue wound care and physiotherapy initiated while on admission. Patient and relatives were very satisfied with the result. They are to continue follow up in order to monitor progress of the limb.

Jafar presented with a Severe Post Infective Left Knee Contracture causing significant limitation of knee movement and functional impairment. The condition is likely due to fibrosis and soft tissue shortening following previous infection. Continued physiotherapy and orthopedic evaluation are recommended. The primary complications of a severe postinfective left knee contracture include permanent joint stiffness, accelerated osteoarthritis, irreversible quadriceps muscle wasting, and chronic gait imbalances that cause compensatory pain in the hip and lower back. Prognosis depends on severity, duration, and response to treatment.