Volkmannʼs Ischemic Contracture in Hemophilia

Hill, Rogers Lee; Brooks, Barney

doi:10.1097/00000658-193603000-00015

Cited by 11 publications

(1 citation statement)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Affection of nerves is both from ischemic pathology (Thomas 1909),3 as well as compressive effect of fibrotic muscle,10 leading to loss of sensation in the distribution of median and ulnar nerve and intrinsic muscle paralysis, which are major problems for a reconstructive surgeon 11. Various causes such as fracture of supracondylar humerus, fracture of both bone forearm, burns, crush injury, aneurysms, hematomas, and forearm fractures have been recognized as causing a peculiar combination of venous and arterial insufficiency which results in delayed appearance of a nerve palsy in hand 121314. Most authors have focused primarily on the forearm flexion contracture, but it is the nerve palsy which is responsible for major functional disability of hand 15.…”

Section: Introductionmentioning

confidence: 99%

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

Meena

Thalanki

Patni

et al. 2016

IJOO

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

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

Meena

Thalanki

Patni

et al. 2016

IJOO

View full text Add to dashboard Cite

show abstract

Ischemic Contracture of the Lower Extremity

Horwitz¹

1940

Arch Surg

View full text Add to dashboard Cite

Massive necrosis of the muscles of the leg after operation for removal of a bone-graft from the tibia

Smith

1939

Journal of British Surgery

View full text Add to dashboard Cite

THE following account of a surgical disaster which occured in my hospital practice some years ago is given because the experience is believed to be unique and no satisfactory explanation of the condition has yet been made. CASE REPORT€IIsToRY.-The patient was a young woman, aged 20 years, well developed and in good general condition, but fat and florid. In cold weather her face and extremities became bluish. She had been in hospital for two and a half years suffering from tuberculosis of the spine, left knee, sternum, and lungs, THE OPERATION.-A bone-grafting operation to arthrodese the tuberculous area of the spine was done when non-operative treatment had arrested the disease in the other sites, but not in the spinal site.A curved incision along the front of the right leg was made, the flap raised, and two massive grafts 6 in. long were cut from the medial surface of the tibia with an electrically driven saw. While these grafts were being cut, the knee was held fully flexed, but no tourniquet was used. The assistant may have exerted some pressure in holding the limb flexed. Owing to difficulties with the saw, the operation on the leg took forty-five minutes, including the opening and closing of the wound; the time of the whole operation on the leg and spine was ninety minutes. Gas-oxygen-ether anaesthesia without intratracheal tube was used, the patient lying in the prone position ; during the first hour she was somewhat cyanosed. The dressing of the wound of the leg consisted of gamgee tissue, the leg being bandaged firmly, but not tightly, to a wooden back splint with foot-piece.SUBSEQUENT PROGRESS.-After the operation, the patient said that the leg felt heavy, but there was no complaint of pain, and the toes were warm and normal in colour. There was a severe degree of shock. The next day, complete loss of sensibility and power of movement below the knee were noted, and the skin-flap of the leg wound was slightly discoloured. Subsequently the edges only of the flap sloughed ; but no other area of skin in the leg or foot became necrotic. When the stitches were removed after a week, the muscles of the anterior compartment of the leg weie seen to be necrotic, and sloughed completely in the following two months. During this time there was intermittent pyrexia, but there were no local signs of inflammation and no constitutional disturbances. The wound in the back healed normally. On separation of slough, a fracture of the tibia in the lower third of the shaft was noticed, but whether this occurred spontaneously or accidentally during nursing of the limb is not known.Three months after operation, the skin behind the heel, over the head of the fibula, and in the middle of the back of the leg opened, and through these openings a large amount of necrotic muscle and blood-stained serum were discharged, The openings then healed rapidly and remained healed. The skin over the plantar aspect of the head of the fifth metatarsal also gave way, with slight discharge of necrotic tissue, and subsequently did nor permanently hea...

show abstract

Volkmannʼs Ischemic Contracture in Hemophilia

Cited by 11 publications

References 0 publications

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

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

Ischemic Contracture of the Lower Extremity

Massive necrosis of the muscles of the leg after operation for removal of a bone-graft from the tibia

Contact Info

Product

Resources

About