Clinical review: Volkmann’s ischaemic contracture

Pettitt, David; McArthur, Paul

doi:10.1007/s00068-011-0079-4

Cited by 8 publications

(3 citation statements)

References 30 publications

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“… 5 6 7 8 Since Baumann's vertical suspension and plastering have been replaced by percutaneous Kirschner wire (K-wire) osteosynthesis as the primary choice in the management of SFH, the incidence of the ACS has declined drastically and is, therefore, rarely encountered anymore by the medical staff. 6 7 9 Typical clinical signs of ACS of the forearm in adults are summarized as the six “P's”: pain, positive passive stretch test, paresthesia, paralysis, painful tense forearm, and at times, a pulseless limb. 10 In children, however, the primary symptoms are rather summarized as the three “A's”: anxiety, agitation, and increased analgesic requirements due to pain out of proportion along with pain on passive stretching.…”

Section: Introductionmentioning

confidence: 99%

“…13 The symptoms of VIC of the volar compartment of the forearm are shown in Table 1 . 9 Physiotherapy, including passive stretching of contracted muscle fibers and joints and splinting to oppose further contractions, has to start immediately. 8 Surgical treatment choices include skin release and Z-plasty for mild contractures, the release of secondary nerve compression, muscle slides, and tendon lengthening in moderate contractures, and finally, tendon transfers or free-tissue transfers as well as salvage procedures for severely contracted or neglected extremities.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostics and Treatment of Volkmann Ischemic Contracture in a Seven-Year-Old Child

Schulze

Schultz

Dragu

et al. 2022

European J Pediatr Surg Rep.

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A 7-year-old boy presented 6 weeks after open reduction and crossed Kirschner wire (K-wire) fixation of a supracondylar humerus fracture. Previous treatments had restored skeletal anatomy without documented complications. However, the patient would not move the entire arm, including his forearm and hand. Any passive movement led to anxious adverse reactions, and there was partial numbness of all fingers. After intensive physio- and occupational therapy supported by nerve stimulation and psychological counseling, anxiety-related functional deficits of the shoulder and elbow resolved to reveal the severe Volkmann contracture of the right hand developed fully. Electroneurography, X-ray, magnetic resonance imaging of the forearm, and ultrasonography showed nonfunctional ulnar and a partially disturbed radial motor nerve distal to the elbow along with damaged flexor muscles of the forearm after compartment syndrome. In addition, damage to the median nerve at the elbow level was diagnosed. After intense conservative therapy, we partially resected fibrotic fascia of the superficial flexor compartment, freed ulnar and median nerves, and performed staircase-like releases of tendons and tenotomies. We achieved a full range of motion of all fingers and markedly improved the range of motion of the wrist. The Disabilities of the Arm, Shoulder and Hand scores for function improved from 80 to 16 at the 2-year follow-up postoperatively, but some impairments of fine motor function persisted. Subtle symptoms of a developing compartment syndrome need to be recognized. Overlooked and untreated, a consecutive Volkmann contracture can turn the extremity nonfunctional. Intensive physical, psychological, and surgical therapy in a specialized center can restore function but requires endurance and perseverance throughout the lengthy recovery.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostics and Treatment of Volkmann Ischemic Contracture in a Seven-Year-Old Child

Schulze

Schultz

Dragu

et al. 2022

European J Pediatr Surg Rep.

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“…1 This may lead to development of compartment syndrome in lower limbs. It is a potentially serious complication following a tibia fracture.…”

Section: Introductionmentioning

confidence: 99%

Compartment pressure changes after closed fractures of tibia

Pillai

2016

Int J Res Orthop

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Background: Compartment syndrome is a potentially devastating situation. Raised intracompartmental pressure has been implicated as the primary pathogenic factor in compartment syndrome. The purpose of the study was early detection of compartment syndrome and corroborating the findings with other physical signs and symptoms, to prevent the onset of ischaemia and subsequent tissue changes that lead to crippling deformities.Methods: The present study was conducted in the Department of Orthopaedics, Pushpagiri medical college hospital, Thiruvalla over a period of 12 months. Closed fractures of tibia admitted to the casualty unit within 36 hours of injury were selected for the study. A total of 24 patients were included with the majority in the age group of 31– 45 years. Whitesides technique was used to measure the compartment pressure. A differential pressure of less than 30 mm Hg was taken as the criterion for diagnosis of compartment syndrome. Results: The present study included 24 patients with affected 25 limbs.15 out of 25 limbs were with lower third fractures (60%) followed by upper third 6 (24%) and middle third 4 (16%). Out of 25 limbs 20 cases (80%) had associated fracture of fibula and 5 (20%) were not associated. In this study, out of 32% cases with increased compartment pressure, one case with upper third fracture (above 45 mm Hg) and one of the case with middle third fracture (20-30 mm Hg) with associated fibula had underwent immediate fasciotomy.Conclusion: Compartment pressure measurement is a very good index for predicting and preventing compartment syndrome. Fasciotomy to fully decompress all involved compartments is the definitive treatment for compartment syndrome in the great majority of cases. Delays in performing fasciotomy increase morbidity.

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