Ilizarov技术矫治重度膝关节屈曲挛缩畸形的临床研究

[目的]探讨应用改良Ilizarov技术矫治重度膝关节屈曲挛缩畸形的方法和疗效。[方法]依据Ilizarov张力—应力法则及其应用技术,按个体化要求,设计、安装膝关节牵伸矫正器,术中穿针固定牵伸器时,两侧的关节铰链应与膝关节的旋转中心一致。术后牵伸前先牵开关节间隙5~10mm,再逐渐牵拉矫正屈膝畸形。牵伸速度应根据患者的耐受程度调整,一般不大于关节水平1mm/d。牵伸过程中应定期实施X线检查,以防止膝关节脱位和关节软骨受压。牵伸矫正的最终要求,若是单纯的软组织型屈膝孪缩,需将膝关节过度牵伸5°~10°,若合并股骨下段前弓畸形,屈膝矫正的程度应减除骨性畸形的角度。然后患肢维持牵伸位持重行走2~4周,再拆除牵伸器,配合CPM机活动膝关节,站立行走时配戴支具维持膝关节矫正位不少于3个月。8例患者因术前合并股骨下段前弓畸形,Ⅱ期实施股骨髁上截骨术矫正。[结果]49例52个膝关节,术前屈膝畸形平均58.50°±21.28°;矫正后屈曲角度平均4.12°±4.61°。38例,40个关节平均随访6.8个月,其中28个关节维持牵伸术后的效果,12个关节屈膝畸形部分复发,平均9.30°±8.24°。[结论]正确使用Ilizarov技术矫治重度的膝关节屈曲挛缩畸形,疗效满意,并发症少;是一种微创、安全、有效的治疗方法。     

Ilizarov外固定架治疗痉挛型脑瘫屈膝畸形

目的：探讨应用软组织矫形加用Ilizarov外固定架矫治痉挛型脑瘫屈膝畸形的方法和疗效。方法：依据Ilizarov张力一应力法则及其应用技术，按个体化要求，安装Ilizarov外固定架，在外固定架屈侧设置2个铰链关节便于撑开，伸侧设置1个铰链关节便于加压。术后3～5d，待患者腿部疼痛、麻木感减轻后开始屈侧撑开，伸侧加压，每日屈侧延长2mm左右。定期检查克氏针的张力，以免固定松动。每2周摄X线片复查，根据目测观察膝关节矫正角度及X线表现及时修正延长、矫形方案。患者3-6周后膝关节角度就可完全矫正，在过伸10°置维持3周，即可拆除Ilizarov外固定架，活动膝关节，然后佩戴下肢伸直位支具行走2-3个月。2例因术前合并股骨下段前弓畸形，Ⅱ期实施股骨髁上截骨术矫正。结果：21例36个膝关节，术前屈膝畸形平均（80．61±25．51）°，矫正后屈曲角度平均（8．91±2．39）°。21例，36个关节平均随访5个月，其中32个关节维持牵伸术后的效果，4个关节屈膝畸形部分复发，平均（9．32±7．33）°。结论：正确使用Ilizarov技术矫治痉挛型脑瘫屈膝畸形，疗效满意，并发症少，是一种微创、安全、有效的治疗方法。     

Ilizarov技术治疗下肢血管瘤致屈膝畸形

[目的]探讨Ilizarov技术治疗下肢血管瘤继发屈膝畸形的临床疗效。[方法]回顾性研究2008年7月~2014年5月,共收治血管瘤致屈膝畸形14例,男6例,女8例;年龄12~27岁,平均22岁,合并马蹄足畸形4例。左下肢5例,右下肢9例,病史1~7年。屈膝畸形20°~55°,平均37.4°;被动伸膝后VAS疼痛评分4~10分,平均7.8分。所有患者均单纯实施Ilizarov膝关节外固定牵伸术;伴有跟腱挛缩马蹄足畸形者,同时行经皮跟腱松解术后安装Ilizarov足踝牵伸器。术后5~7 d开始牵拉矫正屈膝及踝足畸形,牵伸治疗期间,可以扶双拐下地术肢轻负重行走。[结果]14例患者均获随访,时间6~47个月,平均21个月。所有患者屈膝均矫正,膝关节伸直达0°~5°,平均2.2°,合并马蹄足同期矫正,恢复下肢负重力线。被动伸膝后VAS疼痛评分0~5分,平均3.4分。牵拉矫形时间12~37 d,平均17 d;治疗期间未出现持续的针孔及牵拉区域出血,5例牵伸区域针孔周围渗血经针道周围无菌纱布加压、口服云南白药及减慢牵伸速度渗血停止。[结论]采用Ilizarov技术缓慢牵拉矫正下肢血管瘤所致的屈膝畸形,无需开放手术切除畸形血管,避免了开放手术引起的出血风险,能够满意一期矫正屈膝畸形及合并的足踝畸形,恢复下肢负重力线和关节活动度的同时能够有效缓解膝关节活动性疼痛,是治疗血管瘤致屈膝畸形的有效方法。     

先天性胫骨缺如伴重度膝关节屈曲畸形的牵伸治疗1例(附文献综述)

[目的]观察用膝关节牵伸技术治疗先天性胫骨缺如伴重度屈膝畸形的效果。[方法]1例先天性右胫骨完全缺如,股骨下端呈叉状,腓骨头与股骨下端形成不稳定的膝关节,伴屈膝畸形95°,于1岁半实施股骨下端修整术,5岁和8岁时分两期安装Ilizarov膝关节牵伸器,牵拉矫正屈膝畸形达到伸膝0°位,使腓骨头与股骨下端成膝关节,拆牵伸器后装配能稳定膝关节的下肢补高矫形器行走。[结果]首次膝关节牵伸术后5a3个月随访,膝关节屈曲畸形完全矫正,腓骨已出现胫骨化的趋势,腓骨头与股骨下端组成的膝关节已稳定在0°位,患肢配戴补高矫形器能徒手行走。[结论]膝关节牵伸技术,可有效的矫正先天性胫骨缺如伴发的屈膝畸形,安装带膝关节铰链的牵伸器,可将腓骨头与股骨下端控制于中立位,在长期生理性行走应力的刺激下,腓骨发生了胫骨样的变化,可发育成具有类似膝关节形态的结构,整个患肢由于正常的行走使用而得到良好发育。     

新型Ilizarov膝关节牵伸器的研制和临床应用

目的 :探讨用Ilizarov微创技术矫正各种类型膝关节屈曲畸形。方法 :在Ilizarov牵伸器基础上 ,研制了新型膝关节牵伸器 ;包括股骨、胫骨骨外固定器 ,并在膝关节两侧由关节铰链连接。术中安装时确定膝关节伸屈的旋转中心 ,用于伸缩的带弹簧牵伸杆安装在膝后的上下两个钢环上 ,手术中将牵伸器用 2mm克氏针交叉穿股骨和胫骨于膝关节中央 ,术后逐渐旋转牵伸杆 ,膝关节软骨面在避免挤压的情况下慢慢伸直。结果 :2 7例 3 0个膝关节 ,术后平均牵伸时间 5 8d ( 18d～ 10个月 ) ,全部病例膝关节伸直皆达到矫形需要的要求 ,未发生影响治疗效果的并发症。结论 :新型Ilizarov膝关节牵伸器的研制和临床应用技术 ,开辟了一条微创、简便、安全治疗屈膝挛缩的有效方法 ,能够矫正用传统手术难以治疗的严重膝关节屈曲僵直畸形     

计算机辅助Taylor空间支架治疗严重屈膝畸形的临床研究

[目的]探讨应用计算机辅助Taylor空间支架治疗严重屈膝畸形的方法和疗效。[方法]为重度屈膝畸形患者21例24膝安装Taylor空间支架。术后复查膝关节X线片,测量各相关角度、距离及旋转等数据,将数值输入计算机软件计算出每个调节支撑螺杆每日调节距离并按结果调节。一般不大于关节水平2 mm/d。牵伸过程中应定期实施X线检查,以明确牵伸效果,同时可多次测量数据调整牵伸方式,以达到最佳目的。调节期间患者可自主生活,达到预期要求拆去外固定架。本次研究所选患者均为软组织型屈膝畸形,需将膝关节过度牵伸5°~10°,然后患肢维持牵伸位负重行走3~4周,再拆除外固定器。站立行走时配戴支具维持膝关节矫正位不少于3个月。[结果]21例24个膝关节,术后平均牵伸时间37 d(23 d~7个月)。全部病例膝关节伸直皆达到矫形需要的要求,未发生影响治疗效果的并发症。[结论]计算机辅助Taylor空间支架矫治重度膝关节屈曲挛缩畸形,疗效满意,并发症少,是一种微创、安全、有效的治疗方法。     

Ilizarov技术结合矫形支具治疗复杂膝关节畸形的临床研究

[目的]研究、探讨在矫治膝关节畸形中,矫形支具与Ilizarov外固定器结合方法、优点与临床疗效.[方法] 2005年5月～ 2012年12月本科采用Ilizarov技术结合矫形支具治疗膝关节畸形患者36例36膝,其中男23例,女13例,左20例,右16例;年龄6～56岁,平均28岁;脊髓灰质炎后遗症膝反屈畸形17例,术中行腘绳肌紧缩后临时用组合式外固定器固定于屈膝20°位,术后2周拆除股骨外固定做大腿支具并用螺纹牵伸杆跨膝关节继续固定;小腿延长致膝关节屈曲畸形10例,直接做大腿支具跨膝关节固定,后侧用螺纹牵伸杆连接,可逐渐矫正屈膝畸形;膝内翻畸形合并外侧副韧带松弛8例,行胫骨截骨矫形,同期行外侧副韧带重建并用组合式外固定器固定膝关节,术后2周拆除股骨外固定改为大腿支具并用螺纹牵伸杆跨膝关节继续固定;血管瘤致屈膝畸形1例,采用股骨外固定器结合小腿支具牵拉矫正屈膝畸形.[结果] 36例患者中,32例获得8～60个月随访,平均19个月,所有膝关节畸形均获满意矫正,下肢负重力线恢复满意,截骨端愈合时间60 ～ 150 d,平均120 d;外固定针道感染5例,经局部换药处理好转;采用HSS评分系统进行评分,优18膝,良10膝,可4膝,优良率为87.5％.[结论]遵循Ilizarov技术原理,采用Ilizarov外固定器联合矫形支具的方法治疗合并有软组织因素的复杂膝关节畸形,可以获得满意的矫形结果及良好的膝关节功能;具有创伤小、固定灵活、制作简单等优点.     

Ilizarov张力-应力法则结合三关节有限截骨矫正成年人重度马蹄内翻足

目的探讨用Ilizarov张力-应力法则结合三关节有限截骨术矫正成年人重度马蹄内翻足畸形的疗效。方法1996年1月～2003年2月,应用Ilizarov张力-应力法则结合三关节有限截骨一期矫正成年人重度马蹄内翻足患者12例13个足,男9例,女3例;年龄20～36岁,平均26岁;左足4例,右足7例,双足1例。病因先天性马蹄内翻足3例,小儿麻痹后遗足畸形6例,外伤1例,脑性瘫痪后遗足畸形1例,小腿海绵状血管瘤施行放射治疗后遗马蹄内翻足畸形1例。根据病情,术前组装Ilizarov踝足关节牵伸器,术中先实施足的后内侧软组织有限松解和三关节切骨术,依照Ilizarov的穿针固定原则,安装具有三维矫形功能的踝足关节牵伸器。术后7d旋转螺纹牵伸杆,逐渐矫正足内翻、内收和前足下垂畸形,在牵伸矫形过程中患足可负重行走。结果12例患者均获得随访,随访时间7个月～4年,平均15个月,畸形未复发,足持重行走功能良好。术后平均牵伸71d。10例11个足达到0°位全足持重,2例保留15°～20°足下垂角(因合并下肢短缩)。术后无一例发生切口和针道感染、皮瓣坏死、血管神经损伤、骨不愈合等并发症。结论Ilizarov张力-应力法则结合三关节有限截骨矫正成年人重度马蹄内翻足是安全、微创、有效的方法。     

Ilizarov牵拉组织再生技术矫正膝关节重度复合畸形

[目的]探讨Ilizarov牵拉组织再生技术矫正膝关节重度复合畸形(膝关节有2种以上畸形存在,如膝屈曲合并内翻、下肢短缩等)的器械构型、手术方法、术后管理程序与疗效。[方法]遵照Ilizarov牵拉组织再生技术的原理,研制了具有三维矫形功能的膝关节牵伸矫正器,需要同期做下肢延长者,在矫正器的基础上加延长附件。根据膝关节复合畸形的不同类型和骨骼畸形部位,在股骨髁上或胫骨上端截骨,跨膝关节穿针安装固定牵伸矫正器,术后7d缓慢旋转螺纹牵伸杆及其相连的4个万向关节,膝关节的软组织屈曲挛缩、以及并存的膝内翻、外翻、旋转、下肢短缩等骨性畸形能同期缓缓矫正,在牵拉矫正畸形的过程中,患肢可以部分参与持重行走。截骨牵拉处骨愈合后,拆牵伸器,装配膝关节矫形支具行走3~6个月。自1996年5月~2004年2月,共矫正重度膝关节复合畸形14例,年龄5~41岁,平均27岁。共7个病种,其中幼年时膝关节骨骺损伤或感染致膝关节发育畸形4例,其他原因导致膝关节复合畸形10例。[结果]14个病例术后的关节牵拉及骨愈合时间80~390d,平均154d。全部病例膝关节复合畸形皆获满意矫正,双下肢基本等长,行走功能恢复良好,无1例发生针道严重感染、血管、神经损伤、骨不愈合的并发症,但皆并发不同程度的膝关节僵硬。[结论]牵拉成骨技术矫正膝关节重度复合畸形,能够用微创的矫形外科技术同期矫正重度膝关节屈曲、内翻、外翻、小腿旋转和下肢短缩畸形,畸形矫正符合生物学原理,获得了用传统骨科技术无法达到的疗效,具有良好的应用前景。     

Ilizarov外固定器矫正膝关节畸形

 目的 总结Ilizarov外固定器矫正膝关节畸形的临床特点与效果。方法 回顾性分析2003年5月至2010年4月,采用Ilizarov外固定器矫正膝关节畸形的21例（22膝）患者资料,男12例,女9例;年龄8~38岁,平均20.3岁。致畸原因：儿麻后遗症4例,烧伤后遗畸形2例,骨髓炎后遗畸形2例,创伤后遗畸形9例,Blount病2例,多发性骨软骨瘤病2例。其中软组织屈曲挛缩5例,采用跨关节铰链Ilizarov支架组合,后侧逐步牵伸矫正;单纯骨性成角畸形8例（9膝）、骨性成角畸形伴骨短缩7例,采用4柱铰链支架组合,先矫正成角畸形,再牵伸延长矫正骨短缩;骨与软组织复合畸形1例,采用以上两种支架的叠加组合。结果 21例患者佩戴Ilizarov支架的时间为12~36周,平均22.3周;拆除支架时膝关节畸形均获满意矫正,其中16例（17膝）截骨或骨延长者均获得坚实骨性愈合。所有患者均获6~86个月随访,平均32.1个月。关节活动度由术前的102.14°±49.36°改善为随访时126.90°±24.31°。根据日本骨科协会（Japanese Orthopaedic Association,JOA） 膝关节骨关节炎治疗效果判定标准评定患膝功能,术前为（50.24±23.64）分,随访时为（85.71±10.52）分。所有患者随访时均可不扶拐徒手行走,且均可独立生活。2例患膝关节活动度＜ 90°,不能下蹲。结论 Ilizarov外固定器矫正膝关节畸形疗效确切,具有手术创伤小,可随时灵活调整的优点,但也存在与长时间带架相关的缺点。     

Treatment of knee flexion contractures in patients with arthrogryposis

BACKGROUND: Knee flexion contractures in children with arthrogryposis are difficult to treat. The purpose of this study was to assess the effectiveness of posterior knee releases and gradual contracture distraction with an Ilizarov external fixator in correcting and maintaining correction of knee flexion contractures of 40 degrees or greater. METHODS: The medical records and radiographs of 7 consecutive pediatric patients (10 knees) with arthrogryposis and knee flexion contractures of 40 degrees or greater were reviewed. The mean age at surgery was 7.3 years, and the mean length of follow-up was 52.7 months. All patients' knee flexion contractures were treated with posterior soft tissue releases and an Ilizarov external fixator for gradual contracture distraction. Posterior soft tissue releases included hamstrings lengthenings, proximal gastrocnemius release, and release of posterior capsule. RESULTS: The mean total fixator time was 102 days, with a mean correction rate of 1 degree per day. The mean knee flexion contracture was 72.5 degrees preoperatively, and all knees were corrected to full extension, +/-5 degrees. At latest follow-up, the mean contracture was 20.5 degrees, and all knees were ligamentously stable. The mean total arc of motion was 56 degrees preoperatively and 54 degrees at follow-up. Five patients who were previously nonambulatory became ambulatory. Complications included 3 fractures, 2 posterior tibial subluxations requiring frame adjustment, and 3 contracture recurrences (1 in a patient with a popliteal pterygium). CONCLUSIONS: Posterior knee releases and flexion contracture distraction by Ilizarov fixator was effective in improving the mobility of pediatric patients with arthrogryposis. At follow-up, the gradual loss of correction that occurred did not impact on the ambulatory gains made.     

Quadricepsplasty in arthrogryposis (amyoplasia): long-term follow-up

Eight patients with arthrogryposis multiplex congenita (amyoplasia type) (11 knees) with knee hyperextension deformity underwent quadricepsplasty and were analyzed during an average follow-up period of 11 years and 2 months. The results were clinically analyzed based on gait pattern, range of movement, and orthotic requirements. Joint congruency was evaluated by radiography according to the Leveuf Pais classification. A satisfactory result was the correction of the deformity, articular congruency, sufficient range of movement, adequate gait pattern and no need for orthosis. A satisfactory outcome occurred in five of the eight patients (eight knees). We considered an unsatisfactory result when any of these conditions occurred. Our experience demonstrated that the quadricepsplasty corrected the hyperextension deformity of the knee joint, improved function, gait pattern, and maintained the muscle power of the quadriceps.     

Versatility of Ilizarov external fixator in management of foot and ankle deformity

Abstract Traditional methods of correcting foot deformities may be difficult to apply in some conditions, especially in presence of other lower limb problems. This study discusses the versatility of Ilizarov external fixator (IEF) in such cases. It was performed in 34 foot deformities in 33 patients, treated with IEF between 1997 and 1999. The average age of the patients was 15 years. The aetiology of foot deformity was recurrent congenital talipes equinovarus (n=10), neglected congenital talipes equinovarus (n=3), poliomyelitis (n=9), post-traumatic deformity (n=6), post-burn deformity (n=1), arthrogryposis multiplex congenita (n=2), and cerebral palsy, fibular hemimelia and tibial hemimelia (1 case each). Unconstrained IEF was applied for the foot in all cases. The leg construct was applied according to the target: foot deformity alone or associated with other leg problems. IEF construct was extended to the femur in cases with flexion knee deformity and hinges were added. Follow-up continued until overcorrection was maintained for the same period of correction followed by an appropriate cast for 8 weeks. The mean time for deformity correction and Ilizarov stabilisation was 16 weeks, and follow-up period was 23.1 months. The results were good in 31, fair in 2 and bad in 1. Additional procedures were performed, most often in the same operating time. Primary arthrodesis was done for 5 feet and for one revision of failed previous arthrodesis. Open corrective osteotomy for arthrodesis was performed in 2 cases. Two females were treated for flexion knee with bloodless technique. Wire-site infections, wire cut-through a calcaneum and metatarsals and fracture post-IEF removal were observed. Although it is technically difficult, IEF can be considered an effective and versatile way of treating foot and other associated lower limb problems through one-reconstruction attack.     

Long-term results of posterior release surgery for severe flexion contracture of the knee in patients with rheumatoid arthritis

Twelve knees in nine rheumatoid patients with severe flexion contractures were evaluated clinically and roentgenographically for an average of 17.2 years (range, six to 25 years) after posterior release surgery. Preoperatively, the average extension in the 12 knees was 42.5 degrees, and postoperatively it was 10.8 degrees. Even though patients were able to walk postoperatively, the majority had knee pain when they extended their knees soon after surgery. Seven knees required further surgery after correction of the flexion deformity. The average time before reconstructive surgery after posterior release was 11.1 months. In the treatment of severe flexion deformities of the knee in patients with rheumatoid arthritis, posterior release surgery was effective only in correcting the deformity. Posterior subluxation of the tibia, knee pain, and instability occurred soon after surgery. Therefore, patients may require additional reconstructive surgery soon after the posterior release.     

The knee in arthrogryposis multiplex congenita

The functional, radiological, and ambulatory status of 30 patients (58 knees) with arthrogryposis multiplex congenita (AMC) were analyzed after a follow-up of 1-36 years. The muscular imbalance presented in many of these patients corresponded well to the type of deformity. The primary treatment was nonoperative in most cases. In spite of the initial promising results, a significant number of patients underwent operation for residual symptoms. Treatment of flexion contractures seems to be more discouraging than the treatment of extension contractures. On the other hand, the risk for degenerative arthritis seemed to be elevated, especially in the extension-contracture group.     

Surgical management of arthrogryposis in the upper extremity

Arthrogryposis multiplex congenita is a rare congenital disorder in which the extremities are affected with severe resistant musculoskeletal contractures. In the upper extremity, these deformities typically consist of internal rotational contractures of the shoulder, extension deformity of the elbow, flexion and ulnar deviation of the wrist, thumb-in-palm deformity, and digital interphalangeal joint flexion contractures occurring singularly or in combination. At the Houston Unit of the Shriners Hospital for Crippled Children, during the interval from 1962 to 1982, 25 patients underwent 56 operative procedures to correct upper-extremity deformities due to arthrogryposis multiplex congenita. Functional improvement was observed clinically and reported subjectively by the patients or their parents in 75% of the cases.     

Total knee arthroplasty in bony ankylosis in gross flexion

Between June 1993 and December 1994, we performed total knee arthroplasty (TKA) on 27 knees in 24 patients with spontaneous bony ankylosis in severe flexion. The mean age at operation was 43.5 years (30 to 60). No patient had preoperative pain. Three were unable to walk and 21 could manage less than five blocks. The mean duration of the ankylosis was 18.7 years (13 to 25) and its mean position was 105 degree flexion (75 to 135). The preoperative Hospital for Special Surgery Knee Score of 60 points was improved to 87 at the final follow-up three to five years later. All knees were free from pain. The mean range of active flexion in 24 knees was 97 degrees (78 to 115) and the mean arc of movement 91 degrees (78 to 98). The mean fixed flexion deformity was 6 degrees (0 to 25) and the extension lag 8 degrees (0 to 25). Angular deformity was corrected to between 0 degrees and 10 degrees of valgus. Four patients were able to walk one block and 20 five to seven blocks. Thirteen knees (48%) showed some necrosis at the skin edge; one knee required arthrodesis and another resection arthroplasty. One had a recurrence of tuberculous infection requiring arthrodesis. One patient had a rupture of the quadriceps tendon. To date no prosthesis has required revision for loosening. Radiolucency of 1 mm or less about the tibial prosthesis was observed at follow-up in four of the 24 knees. Our results have shown that one-stage TKA and skeletal traction after operation can achieve correction of severe flexion deformity of the knee with marked improvement in the function and quality of life.     

The knee in arthrogryposis

Of 104 patients with arthrogryposis multiplex congenita treated between 1952 and 1982, 74 had significant knee contractures, instability, or recurvatum. The minimum follow-up period was two years. Nonoperative treatment modalities included physical therapy, bracing, and serial casting in 43 patients (78 knees). Thirty-one other patients (46 knees) had 62 operative procedures, including hamstring and posterior capsular release, epiphysiodesis, distal femoral or proximal tibial osteotomy, arthrodesis, and knee disarticulation. Surgery was reserved for the more resistant causes and was recommended only as part of an overall treatment plan including the correction of foot and hip deformities. The average follow-up period for the surgically treated patients was 11 years, with a range of two to 20 years. Recurrence of deformity was frequent, with no one procedure being clearly favored. Physiotherapy alone rarely resulted in clinically significant improvement unless accompanied by prolonged casting and bracing. The most useful surgical procedure in the growing child was posterior capsular release performed in conjunction with hamstring tenotomy. Contractures treated by osteotomies before the completion of growth had a high rate of recurrence.     

Arthrogryposis wrist deformities: results of infantile serial casting.

Arthrogryposis multiplex congenita involving the upper extremity can be associated with significant contractures of major joints. Treatment options to maximize upper extremity motion and function include passive joint stretching, serial casting, or surgical intervention. This study reviewed all patients at Carrie Tingley Hospital with arthrogrypotic wrist flexion contractures treated with passive stretching, serial casting, and custom wrist orthotics to determine the effect on wrist position and function. Seventeen infant patients with distal and classic arthrogryposis used this regimen. Average follow-up was 6 years. The greatest gain in wrist motion occurred after the first casting session for both groups. Patients with distal arthrogryposis had the largest improvement in passive wrist motion, were more functionally independent at final follow-up, and had no recurrence of deformity. Patients with classic arthrogryposis had rigid wrist flexion contractures and a 75% incidence of deformity recurrence after casting. At final follow-up, these patients remained functionally dependent, requiring >50% assistance with activities of daily living, and had less improvement in wrist motion. The authors recommend early casting of infant wrist deformities for both forms of arthrogryposis. If the wrist deformity recurs, repeat serial casting is unlikely to improve wrist extension. Other treatment options may be considered in the older child.