Ilizarov gradual correction of severe post-burn bilateral knee flexion and ankle equinus contractures in an 11-year-old: a case report

Introduction and importance: Post-burn contractures involving major joints present significant functional challenges in pediatric patients. Conventional treatments including splinting and surgical release often fail to achieve lasting correction and carry high complication risks. The Ilizarov method, utilizing gradual distraction and histogenesis principles, offers a potentially safer alternative. This case demonstrates successful bilateral Ilizarov application in a severely disabled child, contributing evidence for this technique’s efficacy in pediatric burn contracture reconstructions. Presentation of case: An 11-year-old non-ambulatory girl with bilateral knee flexion contractures (40° fixed flexion) and ankle equinus deformities following deep burns sustained in 2021. Despite multiple soft tissue surgeries, the patient remained wheelchair-dependent for 4 years. Bilateral Ilizarov circular external fixation frames were applied with gradual distraction at 1 mm/day. Treatment duration was 8 months, followed by casting and orthotic support. Clinical discussion: The Ilizarov technique achieved marked improvement in knee range of motion and ankle dorsiflexion without neurovascular complications or pin-site infections. At 1-month follow-up, the patient regained independent ambulation with walking frame assistance. Gradual correction allowed simultaneous soft tissue adaptation, avoiding complications associated with acute surgical release. However, literature reports recurrence rates up to 74% in pediatric burn contractures, emphasizing the need for sustained physiotherapy and orthotic support. Conclusion: The Ilizarov method allowed safe, gradual correction of severe pediatric burn-related knee and ankle contractures, improving function. High recurrence risk requires physiotherapy, orthotic support, and long-term follow-up. Further studies are needed to optimize sustained correction and minimize recurrence.