Management of Volkmann’s Ischemic Contracture: Case Series of 32 patients

Abstract

Introduction: Volkmann’s contracture condition is of high prevalence in our population and is linked to therapeutic faults. The treatment and its results are determined according to the severity of the lesions. Methods: This retrospective study was performed in three centers and was conducted over 30 years (1987–2018); it included 32 patients. The disabilities of the arm, shoulder and hand (DASH) score and the Weber test were used to evaluate the functional outcome looking at mid and long-term results. Results: Thirty-two patients were treated for Volkmann’s Ischemic Contracture (VIC). The age ranged from 4 to 58 years, with 19 patients aged under 15. Wrist fracture was the predominant cause in 16 cases. Fourteen patients obtained a completely functional hand, seven good functional results, four fair functional results, and seven poor results. Discussion: In comparison with other studies, we noticed significant differences: apart from the dominant male sex and right side, this is one large case series conducted over 30 years (1987–2018) looking at mid-and long-term results. All the patients presented with severe or moderate lesions on the first visit. In our study, the wrist fracture is predominant compared to elbow fractures and soft trauma. X-rays are especially helpful and are a first-line investigation for identifying displaced fractures and other associated lesions. Our study population is not large, and the treatment methods are varied, so it is impossible to provide statistically relevant correlations between the treatment method and outcome. But this work is based on the experience of more than 30 years, which makes it possible to help adequate decision making according to the state of the lesions. This study is a level IV case series.

Tendon Transfers to Improve Grip and Pinch in Patients with Sporadic Inclusion Body Myositis

“…If tendon transfers are not an option, a free muscle graft can be considered, because this is the case with severe cases of Volkmann ischemic contracture, which has a clinical presentation similar to that of sIBM in that patients experience restricted digit and wrist flexion. 22…”

“…If tendon transfers are not an option, a free muscle graft can be considered, because this is the case with severe cases of Volkmann ischemic contracture, which has a clinical presentation similar to that of sIBM in that patients experience restricted digit and wrist flexion. 22 In terms of approach, a modified Burkhalter transfer with end-to-side coaptation using a Pulvertaft weave would allow for range-of-motion and improvement in strength. The surgeon should set the tendon tension so that it mimics natural resting muscle length; tendons that are over-or under-tensioned will yield inefficient interactions between myosin and actin filaments, thus reducing the strength of the MTU.…”