Results of neurolysis in established upper limb Volkmann’s ischemic contracture

Abstract

Background:Treatment of established cases of Volkmann's ischemic contracture (VIC) of upper limb is very tedious. Since the period of Volkmann, various experimental works are being performed for its treatment, but none are effective. Disabilities from nerve palsy and hand muscle paralysis are more problematic than any other deformity in VIC. To solve these problems, we conducted a study to see the result of neurolysis of median and ulnar nerve and their subcutaneous placement in established cases of VIC.Materials and Methods:Twelve cases of established VIC operated between July 2007 and August 2010 with complete records and followup were included in the study. VIC of lower limb and contracture of nonischemic etiology were excluded from the study. Their evaluation was done by the British Medical Research Council grading system for sensory and motor recovery. Followup was done for an average period of 24.3 months (range 15-30 months) (the average age was 8.3 years).Results:To study the results, we divided the cases into two series. One group consisted of cases which were operated within 6 months from onset of VIC. The second group consisted of cases which were operated after 6 months from onset of VIC. Our results revealed that there was no statistically significant difference between the two groups operated, though both had significant improvement in motor and sensory recovery in both median and ulnar nerve distribution.Conclusions:Neurolysis of the nerves definitely improved the outcome for motor and sensory components of median and ulnar nerves but the timing of the surgery did not play a role in the outcome contrary to the clinical assumption. This study can serve as a template and further such studies could help us find the answer to a long standing issue.

Clinical and Demographic Profile of Volkmann’s Ischemic Contractures Presenting at National Institute of Rehabilitation Medicine, Islamabad, Pakistan

“…Sharma et al from India reported an age-range of 3-25 years, with 18 years as the average age at presentation. Meena et al 7 from Iran reported 8.3 years as the average age of their patients. 6 In this study, a significant proportion of patients developed VICs following their treatment for forearm fractures by traditional bone setters in the rural locales.…”

“…Sharma et al from India reported an age-range of 3-25 years, with 18 years as the average age at presentation. Meena et al 7 from Iran reported 8.3 years as the average age of their patients. 6 …”

“…6,10 Sundararaj et al 11 from India and Meena et al from Iran, have reported similar cases of forearm fractures managed by non-doctors as the leading cause of VICs among their patients. 7 Contrary to the situation in the developing world, among the cases of VICs reported from the developed countries, supracondylar humeral fracture has been identified as the most common cause of VIC. This fracture is relatively common among children aged around 7 years, where the supracondylar area is undergoing active remodeling and is markedly thinner, hence predisposing it to fracture.…”

“…Similarly Meena et al from Iran reported a series of 12 patients, where 9 were males and 3 were females. 7 More frequent affliction of males with the devastating condition is probably a reflection of their more frequent involvement in out-door and risky activities that predispose them to the initial inciting traumatic events, which subsequently culminate in the development of VICs. 8,9 There was more frequent affliction of the relatively younger segment of the population in this study.…”

“…Similarly Meena et al from Iran reported a series of 12 patients, where 9 were males and 3 were females. 7 …”