Prevention of neurovascular complications in extension osteotomy of the tibia in poliomyelitis.

Extension osteotomy of the proximal tibia was carried out in patients with quadriceps weakness after poliomyelitis in order to obtain a stable knee during the stance phase. Blood flow in the anterior and posterior tibial arteries was measured by Doppler sonography before, during and after operation. It was found that there was a correlation between the degree of extension of the knee after operation and a diminished blood flow. This probably explains some of the neurovascular complications reported in the literature after this procedure. We recommend that blood flow is monitored sonographically in the postoperative phase and that optimum extension is obtained gradually over a period of time in a hinged plaster cast.