Management of Volkmann's Ischemic Contracture: Case Series of 32 patients.

Otman Benabdallah,Rania Benabdallah,Mohamed Shimi,Hicham Ait Benali,Ahmed Khamlichi

doi:10.1051/sicotj/2021055

Otman Benabdallah, Rania Benabdallah + Show 3 more

Open Access

https://doi.org/10.1051/sicotj/2021055

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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.

Highlights

In 1881, Volkmann [1] described a condition of muscular ischemia, necrosis, and subsequent contracture of the forearm
Excessively, the traditional healer is unaware of the danger of compartment syndrome or Volkmann’s contracture, which is why the urgently needed management is not provided, resulting in serious complications including anaerobic infection with gas gangrene (Figure 1), common bacterial infections, osteitis, and severe contractures characterized by necrosis of all flexor muscles and extensor muscles, which further complicates the treatment
In literature [6, 13, 14, 19], Volkmann’s ischemic contracture (VIC) secondary to supracondylar fractures is found in 10.07% to 60% of cases, while it is secondary to fractures of both of the forearm bones in 54.6% of cases

Summary

Introduction

In 1881, Volkmann [1] described a condition of muscular ischemia, necrosis, and subsequent contracture of the forearm. The envelope in question consists of the fascia and bone surrounding the muscle, but skin and external restrictions such as encircling dressings and plaster splints may contribute to the situation [2,3,4] It highlights that the muscle can only tolerate 4 h of ischemia before irreversible changes occur [2]. Severe pain results, but even if the patient complains excessively, the traditional healer is unaware of the danger of compartment syndrome or Volkmann’s contracture, which is why the urgently needed management is not provided, resulting in serious complications including anaerobic infection with gas gangrene (Figure 1), common bacterial infections, osteitis, and severe contractures characterized by necrosis of all flexor muscles and extensor muscles, which further complicates the treatment.

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Conclusion