Results of the Max Page muscle sliding operation for the treatment of Volkmann’s ischemic contracture of the forearm

Abstract

BackgroundVolkmann’s ischemic contracture is a less common but crippling condition affecting the extremities. Once the condition sets in, the prognosis always remains guarded, even after long and intensive physiotherapy and various restorative surgical techniques. This study was undertaken to evaluate the long-term functional results of the Max Page muscle slide operation in patients with Volkmann’s ischemic contracture of the forearm of moderate degree (Tsuge classification).Materials and methodsNineteen patients treated between 1997 and 2009 were evaluated. The functional outcome (measured as the dexterity score, hand grip strength, sensibility, and appearance) was analyzed postoperatively. The pre- and postoperative values were compared using a paired t test. The final results were graded as good, fair, and poor.ResultsThe average age at the time of presentation was 18 years (range 3–25 years). Tight external splintage for injuries around elbow and forearm was the primary factor. The mean period of follow-up was 3.53 years. Fifteen patients were able to achieve good functional results. Three had fair and one had poor results. All three variables showed significant improvements postoperatively. Wound dehiscence was the most common complication. One patient needed a second surgery to restore good hand function.ConclusionThe Max Page muscle sliding operation to treat Volkmann’s ischemic contracture of moderate degree gives good functional results. The procedure is simple and easy to perform. Adequate muscle release and proper postoperative physiotherapy are key to achieving good results.

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

“…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. In all these cases, tight constricting bandages had been fashioned with locally available bamboo sticks (Figure 1).…”

“…Approximately 20% of these fractures are associated with some form of vascular compromise. 6,[12][13][14] Electric burns constituted the second most common group of patients with VICs in the current study. We are faced with the menace of burns particularly the high voltage ones, which have many long term repercussions including VICs.…”

“…The current observations conform to similar findings reported by authors from other developing countries. 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.…”

“…Our finding conforms to similar observation reported in several published studies from the developing world. For instance, Sharma et al 6 from India reported a series of nineteen patients with 12 males and 7 females. Similarly Meena et al from Iran reported a series of 12 patients, where 9 were males and 3 were females.…”

Reconstruction of a Chronic Volkmann Contracture following Forearm Revascularization with Burkhalter's Procedure and Fractional Flexor Tendon Lengthening after a Failed Stiles-Bunnell Transfer

“…Because of the extent of muscle degeneration, and even if the deformity can be improved using flexor tendon lengthening or muscle sliding, the grip strength is expected to be markedly decreased and in particular the power of flexion of the distal IPJ. In a review of 19 patients, performed by Shama and Swamy, 19 most patients (14 cases) were able to achieve grip strengths in the good range (within ≥ 75% of the normal limb). However, preoperatively, most patients like in this report, are unable to perform the test due to the deformity, and poor grip was already present.…”