Three-year (2014-2016) activity report of the Replantation Service for hand amputations in Poland.

The paper summarizes 32 months (January 2014 - August 2016) of activity of the Replantation Service for hand amputation in Poland. Over this period a total of 568 cases of total and subtotal amputations as well as other complex injuries to the hand were referred. Of these, 354 referrals (62%) were accepted and 214 (38%) rejected. Among accepted, there were 167 total (47%) and 142 subtotal (40%) amputations; 45 patients (13%) had other severe hand injuries. Vast majority of the patients constituted males aged a mean of 39 years. The most common injury was amputation of several digits in one patient, and thumb amputation - a total of 229 cases (65%), followed by transmetacarpal and wrist amputations - 92 (30%) and forearm/arm amputations - 33 cases (9%). Replantation of amputated extremity was performed in 141 patients (40%), revascularization in 145 (41%) and in 29 (8%) primary repair of the complex injuries. In 27 cases (8%), a coverage of the tissue defects, and in 12 (3%) primary terminalization was performed. Survival rate was of 78% for replantation and revascularization. Comparing to the period 2010-2012, an increase in number of treated patients (of n=64 cases), in number of amputations (of 96 cases) and in number of amputated digits (of 88 cases) were noted. The activity report shows importance of Replantation Service, an informal structure, in saving limbs of severely mutilated patients.

The Physical and Psychosocial Benefits of Upper-Limb Transplantation: A Case Series of 5 Polish Patients.

BACKGROUND: Although upper-limb transplantation is not a life-saving procedure, every year more and more patients are ready to undergo this surgery. Conventional methods of treatment performed earlier have not brought the expected functional and aesthetic results. Patients who have received upper-limb transplantation (HTx) enjoy, in addition to the physical benefits associated with good functional effect, numerous benefits of a psychological and social nature. Investigation of these benefits was the aim of this interdisciplinary research. CASE REPORT: The wide spectrum of physical, psychological, and social benefits derived by recipients of limb transplantation include: improved physical fitness, recovery of the complete body form, corporeal well-being, enhanced self-esteem, recovery of self-confidence, a stable feeling of personal and social identity, higher integration of the body with performed social roles, greater confidence in the ability to act and have control over life, a feeling of greater security, the ability to return to work, restoration of social position, and positive personality changes. CONCLUSIONS: Potential benefits which may be derived by future upper limb recipients are manifested in the good functional effect of the transplantation, enhanced life satisfaction, and better functioning in society. It does not mean, however, restoration of 100% of fitness or absolutely problem-free functioning in everyday life, which is extremely important in the context of prevention of possible disappointment to future limb recipients.

New concept of scapholunate dissociation treatment and novel modification of Brunelli procedure - anatomical study.

BACKGROUNDS: This paper describes a novel method in treatment of scapholunate dissociation accompanied with rotatory subluxation of the scaphoid. The idea of this method is to create a kind of axial lever that can fully reconstruct anatomical relationship between the scaphoid and the lunate, with no involvement of extrinsic ligaments, and with simultaneous restriction of pathological alignment of the scaphoid. Based on this technique, we have also proposed a new modification of Brunelli procedure in scapholunate dissociation with rotatory subluxation of the scaphoid and dorsal intercalated segmental instability. METHODS: At the initial stage of the study, 20 human wrists fixed in Ethanol were used, followed by 12 fresh human wrists used in part two. The first stage included functional, biomechanical and strength tests carried out by means of a 5 kg load and intended to find the most anatomical and durable treatment method. The second stage involved testing the proposed methods on fresh cadaver wrists. RESULTS: We have discovered that the new method is able to recreate anatomical forces and properties of scapholunate ligament; what's more, it can also prevent rotatory subluxation of the scaphoid. The performed strength tests have proven that it is possible to treat scapholunate instability also in case of dorsal intercalated segmental instability. CONCLUSIONS: We highly recommend using both the new technique and the new modification of Brunelli procedure for treatment of scapholunate dissociation in both dynamic and static instabilities.

"Dangerous" anatomic varieties of recurrent motor branch of median nerve.

UNLABELLED: Carpal tunnel release became one of the most common operations in the field of hand surgery. Many controversies has been made about frequency of the so-called dangerous variations of motor branch of the median nerve. Knowledge of all the anatomical variations motor branches is the duty of every surgeon dealing with the subject. The aim of the study was to present the incidence of dangerous variants of median nerve motor branch in the carpal tunnel based on both clinical experience and anatomical studies performed on 20 cadaver wrists. MATERIAL AND METHODS: Between 2006-2012 during minimally open carpal tunnel release we made photographic documentation of all visible dangerous varieties of recurrent motor branches of the median nerve. We also studied 20 cadaver wrists in the Department of Anatomy Medical University in Wroclaw. RESULTS: Dangerous varieties of the motor branch of median nerve was found in three clinical cases and in one cadaver wrist. Also In one wrist we found one regular branche, which, however, has atypical two separate branches supplying the thenar muscles. CONCLUSIONS: Dangerous varieties of the motor branch of median nerve occur very rare in the population, but does not release from the fact that in each case special attention must be given.We also conclude that, at the minimally open carpal tunnel release procedure, the transverse carpal ligament should be released rather from the line of radial border of the 4th finger to minimize the risk of injury to the recurrent motor branch of median nerve.

Post-traumatic thumb reconstruction with radial forearm flap.

The study described a case of a 37-year-old patient, who had undergone avulsion amputation of the thumb, and was subject to a primary thumb reconstruction by means of thumb reconstruction with radial forearm flap, with the use of osseous fragments of the amputated thumb parts.

Treatment possibilities of reverse-flow sural flap in covering the defects of lower extremities.

UNLABELLED: Soft tissue defects of the lower extremity pose an important surgical challenge, often because of inviability of primary covering. Therapeutic modalities of choice comprise of local perforator flaps, as well as of free flaps created with the use of microsurgical skills. However, these methods cannot be applied in patients with important comorbidities, and it is in such cases where the reverse sural flap proves to be the best solution. THE AIM OF THE STUDY: To present the results of treating lower extremity defects with various modifications of the reverse sural flap. MATERIAL AND METHODS: Sixteen patients, males aged 17-56 years, were operated on from 2007 to 2013. Diabetes with multiple complications, disseminated atheromatosis, and extensive soft tissue trauma involving the arteries crucial for microsurgica anastomoses were the most common reason disqualifying from the free and perforator-based flap techniques. RESULTS: All of the patients achieved very good results; in two cases distal and marginal flap necrosis was observed which, once exiced, covered with granulation, and was successfully covered with a partial-thickness skin graft. CONCLUSIONS: The reverse sural flap, technically easy, offers a viable, low-risk alternative to free and perforator-based flaps.

Surgical treatment of hemangiomas and arteriovenous malformations in upper extermity.

UNLABELLED: Hemangiomas belong to one of the most common type of tumors occurring in childhood. They are benign and often do not require any treatment, with the tendency to. frequently disappearing spontaneously at the age of 5-7 years. The tumors usually develop in the head and neck area, whereas vascular malformations (AVMs) are rare congenital anomalies, which may occur anywhere. In upper limb, they may amount to 30-60% of cases. It is common for these changes not to require any surgical treatment. In case they do, the main indications for such treatment of upper limb AVMs may be as follows: signs of compression of the peripheral nerves, limited mobility of the fingers because of the tumor, which entails difficulties in the functioning of the whole arm, pain and aesthetic considerations. AIM OF THE STUDY: was to present the results of surgical treatment of vascular tumors (hemangiomas and AVMs) in the upper limb that was applied in our department, as well as a broader discussion on epidemiology, diagnosis, and treatment of these changes. MATERIAL AND METHODS: In 2003-2011 period we treated 11 patients aged 24-39, suffering from vascular tumors (hemangiomas / vascular malformations) in the upper limb; the group included 3 men and 8 women. In this group we diagnosed 2 cases with arm hemangiomas, 2 cases of intramuscular hemangiomas of the forearm, 2 cases of hemangiomas in metacarpal area, 2 cases of AVMs of the finger and metacarpal area, and 4 cases of isolated vascular malformations (mainly arteriovenous malformations) of the fingers. All preparations were examined histologically. RESULTS: No complications or recurrence were found in 7 cases, recurrences of AVMs were observed in 4 patients with finger changes. In one patient with AVMs of the index finger, we observed a treble recurrence, which severely impaired functioning of his hand. We eventually suggested to him the finger amputation, to which the patient agreed. CONCLUSIONS: Upper extremity is a rare location of hemangiomas and other vascular malformations requiring surgery. hemangiomas are more common in women, and the occurrence of AVMs in both males and females is similar. Surgical treatment of hemangiomas and AVMs of the upper extremities is doubtlessly an arduous task, which calls for great microsurgical skills.

Standardizing skin biopsy sampling to assess rejection in vascularized composite allotransplantation.

Over 70 hands and 20 faces have been transplanted during the past 13 yr, which have shown good to excellent functional and esthetic outcomes. However, (skin) rejection episodes complicate the post-operative courses of hand and face transplant recipients and are still a major obstacle to overcome after reconstructive allotransplantation. This article summarizes all relevant information on the skin component and rejection of a vascularized composite allograft. As more and more centers plan to implement a vascularized composite allotransplantation (VCA) program, we further develop guidelines and recommendations on collection and processing of skin biopsies from hand and face allograft recipients. This will help to standardize post-operative monitoring, avoid pitfalls for those new in the field and facilitate comparison of data on VCA between centers.

Unsuccessful replantation of metacarpal hand after venous thrombosis--case report.

Trans-metacarpal hand replantation is one of the most complex and difficult procedures in the reconstructive microsurgery. As far as we know the arrangement of the palmar arterial network, the problem lies in the absence of accurate venous maps at the dorsum of the hand. The quality of venous circulation structure at the replanted hand determine the success of the surgery. In this paper we present a case of a failed replantation of a metacarpal hand after early thrombosis at the venous microcirculation system.

[An example of multi-stage reconstruction of a full-thickness abdominal wall defect]. / Przyklad wieloetapowej rekonstrukcji pelnej grubosci ubytku sciany jamy brzusznej.

Abdominal wall reconstruction is a highly complex procedure that may requires a multiple stages surgical operations. The aim of a such reconstruction is to close the abdominal wall defect and to create a support for the internal organs. It's a challenge for both general and reconstructive surgery. An incomplete thickness defects of the abdominal wall are so much easier to challenge than complete ones. Also the size of the primary defect determines the way and stages of the operation. Such defects can occur in necrotizing fasciitis of the abdominal wall, after abdominal walls tumors removal, in traffic accidents or after "open abdomen" procedures (acute severe pancreatitis). In this paper the authors present a case of 62-yo patient which was operated because of large intestine perforation with various complications of which the most serious was the abdominal wall defect.

Epidemiological characteristic of acute pancreatitis in Trzebnica district.

Acute pancreatitis is one of the most common surgical disease, and thus cause of hospitalization. Incidence and etiology of this condition demonstrates large regional differences. This situation is a substantial financial burden forhospital district, and changes in organization structure and funding medical service should be taken under consideration.The aim of the study was to record the epidemiology with etiology, diagnosis and treatment of acute pancreatitis in large district (77 000 inhabitants).Material and methods. A meta-analysis study of all 298 patients admitted to Hospital St Hedwig in Trzebnica, in the six-year period from 2005 to 2010, with acute pancreatitis was performed.Results. Acute pancreatitis was diagnosed in 298 patients in the six - year period, giving an estimated incidence of 64.4 per 100 000. Among the group of 441 admissions for acute pancreatitis in 298 patients was confirmed. Severe acute pancreatitis developed in 22.5% (67/298) of patients, more often in males 56/208 (27%) than in females 11/90 (12%). Gallstones were found as an etiological factor in 27% (80/298), and alcohol intake in 49% of patients. 211/298 (70%) patients had only one attack, whereas 29% (87/298) were readmitted with 230 relapses. The risk of recurrent pancreatitis was 48% in alcohol induced and 6,25% in gallstone induced pancreatitis. 53/298 patients (17%) were operated, ERCP procedures were performed in 24.Performed operations: necrosectomy in 25/53 (47%), elective cholecystectomy in 16/53 (30%), open drainage of abdominal abscess in 5/53 (9%), open drainage of cysts in 5/53 (9%), Jurasz's operation in 2/53 (3%). Majority surgical treatment was carried out in 68% cases with severe acute pancreatitis. Mortality due to acute pancreatitis was 3% (10/298); 15% in severe pancreatitis.Conclusions. 1. Acute pancreatitis continues to be an important clinical problem. 2. Severe, necrotic acute pancreatitis is associated with high mortality rates. 3. The ethanol-intake-related episodes of acute pancreatitits are much more prevalent than the gall-stone-related ones. 4. After the exclusion of ethanol- and gall-stones-related etiologies, the subsequent diagnostic process should aim at excluding neoplastic process of the head of pancreas.

Three-year activity report of the replantation service for amputation of the hand in Poland.

UNLABELLED: A permanent on-call service for hand amputation (Replantation Service) was established in 2010 as the initiative of the Council of Polish Society for Surgery of the Hand. It is run by three qualified hand centres in Trzebnica, Poznan and Szczecin. The aim of the study was to present a summary of the almost three-year activity of this service. MATERIAL AND METHODS: Over this period, a total of 435 cases of total amputations, subtotal amputations and other severe injuries to the hand were referred. Of these, 290 referrals (67%) were accepted and 141 (33%) rejected. Among accepted, there were 100 total (34%) and 113 subtotal (39%) amputations; 81 patients had other, severe hand injuries, such as crush, degloving and extensive wounds involving all tissues. RESULTS: Young and middle-age males constituted the majority of patients with the mean age of 42 years (range 2-82). The most common injury was amputation of several digits (including thumbs) in one patient - 141 cases (48%), followed by amputations from the metacarpal- to the proximal forearm level -115 (39%) and elbow/arm level - 9 cases (3%). Niniteen patients (6%) had multi-level amputation or injury of the involved extremity. Replantation of the completely amputated extremity was performed in 83 patients (28%), revascularization in 95 (32%) and in 59 (20%) primary repair of the complex injuries. In 23 cases, the repair of tissue defects was performed with flaps, mostly with greater omentum. Survival rate was of 84% for replantations and 88% for revascularizations. CONCLUSION: Establishing of the Replantation Service constituted a significant progress in organization of the management of the most severest upper limb injuries.

World experience after more than a decade of clinical hand transplantation: update on the Polish program.

It has been demonstrated over the past decade that the generally achieved functional outcomes of patients after hand transplantation (HTx) are better than those of equivalent replantations. However, HTx should be performed in specialized centers with Institutional Review Board-approved transplantation programs. In Poland such requirements are fulfilled by The Subdepartment of Replantation of Limbs of St. Jadwiga Hospital in Trzebnica. A main emphasis of this subdepartment is to make the very involved process of donor recruitment, recipient screening, surgery, and postoperative treatment fully transparent. This article summarizes the experience of this center with HTx over the past 5 years.

Chimerism in hand transplantation.

Hand transplantation (HTx), a non-life saving reconstructive procedure, significantly improves the quality of life of upper limb amputees. However, HTx recipients need to take immunosuppressive drugs for the remainder of their lives and, despite dramatic improvements in the safety of modern immunosuppressive protocols, these patients continue to suffer from adverse effects, a fact which raises ethical doubts regarding the legitimacy of HTx given its non-life saving nature. Furthermore, the effectiveness of immunosuppressive treatment in preventing chronic rejection remains unclear. In order to circumvent these important impediments, the ultimate goal of composite tissue allografting (CTA) needs to be the induction of donor-specific tolerance. A possible way of attaining this objective may be chimerism, the coexistence in the host organism of 2 populations of cells of both donor and recipient origin. Clinical experiments of solid-organ transplant recipients and CTA research in animal models provide promising perspectives for establishing chimerism with the use of the facilitating cells and regulatory T-cells. This article reviews the available data on achieved chimerism in HTx and the relevant literature.

The International Registry on Hand and Composite Tissue Transplantation.

BACKGROUND: The International Registry on Hand and Composite Tissue Transplantation was founded in May 2002, and the analysis of all cases with follow-up information up to July 2010 is presented here. METHODS: From September 1998 to July 2010, 49 hands (17 unilateral and 16 bilateral hand transplantations, including 1 case of bilateral arm transplantation) have been reported, for a total of 33 patients. They were 31 men and 2 women (median age 32 years). Time since hand loss ranged from 2 months to 34 years, and in 46% of cases, the level of amputation was at wrist. Immunosuppressive therapy included tacrolimus, mycophenolate mofetil, sirolimus, and steroids; polyclonal or monoclonal antibodies were used for induction. Topical immunosuppression was also used in several cases. Follow-up ranges from 1 month to 11 years. RESULTS: One patient died on day 65. Three patients transplanted in the Western countries have lost their graft, whereas until September 2009, seven hand grafts were removed for noncompliance to the immunosuppressive therapy in China. Eighty-five percent of recipients experienced at least one episode of acute rejection within the first year, and they were reversible when promptly treated. Side effects included opportunistic infections, metabolic complications, and malignancies. All patients developed protective sensibility, 90% of them developed tactile sensibility, and 82.3% also developed a discriminative sensibility. Motor recovery enabled patients to perform most daily activities. CONCLUSIONS: Hand transplantation is a complex procedure, and its success is based on patient's compliance and his or her careful evaluation before and after transplantation.

Quality of life-oriented evaluation of late functional results of hand replantation.

BACKGROUND: Forearm amputation in different zones via a similar mechanism in a group of patients of similar age is associated with different possibilities of functional recovery. The degree of postoperative recovery of function is invariably partial compared to pre-amputation function; this kind of trauma inevitably leads to disability. The patients adapt to their new circumstances to a different extent. That is why a quality of life evaluation should be included in the assessment of replantation outcomes. The aim of the study was to evaluate functional outcomes in patients after replantation at the metacarpal, wrist and mid-forearm level with regard to the quality of life of this patients. MATERIAL AND METHODS: Thirty patients (29 men, 1 woman) of an average age of 41 years who had had replantation or revascularization surgery of an upper limb at different levels took part in a randomized study. The patients were divided into 3 groups depending on the level of amputation: metacarpal, wrist, mid-forearm, with 10 patients in each group. Amputations had been done by a circular saw (21) or via a guillotine mechanism (9). The patients were evaluated on average 4.2 years postoperatively. The following parameters were assessed: total range of active motion (the long finger with the greatest range of motion was assessed) (TAM), grip strength, and sensation; patients performed the Nakamura-Tamai test (modified). Overall functional outcomes were assessed according to Chen's classification. The quality of life (QoL) was measured with the SF-36 questionnaire (0-136 points). The correlation of functional and QoL results was assessed by Spearman's non-parametric test. RESULTS: Average TAM was: 167 degrees in metacarpal, 174 degrees in wrist, 114 degrees in mid-forearm group; grip strength was 0.7 N, 0.9 N and 0.6 N respectively. All patients had at least protective sensation, whereas a 2PD of less then 10 mm was present in 4 patients in the metacarpal group, and 6 patients in the wrist group. In Chen's classification 5 patients in metacarpal group were rated as grade I and II, compared to 7 in the wrist group, and 2 in the forearm group. QoL scores were 98.9, 104 and 82 respectively. A strong QoL-function correlation was confirmed in the wrist and forearm groups (0.73 - 0.81 respectively), and in the metacarpal group it was weak (0.43). CONCLUSION: The quality of life of patients of the designated groups was correlated with their functional results.

Transplantation of amputated bony phalanges as a salvage thumb reconstruction method - a preliminary report.

BACKGROUND: Every traumatic amputation of the thumb is an indication for an attempt of replantation. Due to local state of the wound not every case qualifies for this procedure. Such patients may be offered a multi-step salvage reconstruction of the amputated finger; the first step consists of an emergency implantation of the bony phalanx under the skin of the abdominal wall. The osseous graft was covered with skin using a pedicled tubular flap or a "cutaneous pocket". The aim of this paper was to evaluate the effectiveness of this reconstructive method. MATERIAL AND METHODS: Over a period of four years, we operated on 24 patients (22 males, 2 females) aged 17 - 56 years (mean 31.3 yrs); trauma affected the dominant hand in 16 cases (66%); 17 patients (71%) lost their thumbs at the level of IP joint ; in the remaining 7 cases (29%) the amputation was at the level of the MCP joint. In 3 cases with concomitant amputation of the 2nd and 3rd fingers, the grafted structure was the bony phalanx of the index finger. The grafted phalanx, its soft tissues pared off, was joined with the proximal phalanx or the 1st metacarpal bone with two K-wires and then covered with a pedicled tubular flap or implanted to a cutaneous pocket preformed from the abdominal wall. The flap and the "pocket" were cut away on average after 30.2 days. The cutaneous plasty of the finger was performed on average after 11.3 weeks; the sensory island was transferred according to Littler in 18 patients on average 22.2 weeks after the amputation. The evaluation included: osteosynthesis, mobility of the finger (Kapandji's test), pinch-grip strength, touch sensation (filament and discriminatory, temperature sensitivity), esthetics of the finger, and the employment status of the patients. RESULTS: Failure of losing the graft occurred in 3 patients (12%) and was due to an infection unresponsive to treatment and developing on necrotic flaps. Five patients (21%) developed marginal necrosis within the fragments of the cut off flaps requiring cutaneous plasty; an inflammation of the recipient site occurred in 5 cases (21%). 18 patients (75%) of the patients turned up for the distant follow-up on average 13.2 months after the accident (range 11 - 28 mths). 16 patients (89%) had good bone union; in 2 cases the distal part of the graft had been resorbed. All of the patients were able to touch the pseudo-ball of the thumb with the 5th finger. The strength of the pinch-grip on average reached 3.3 kG (range 1.8 - 6.2 kG), which equals to 55% (range 36 - 78%) of the uninjured hand. Touch sensation was satisfactory in 16 patients (89%) (blue filament), reduced in 2 (11%); 6 patients (33%) showed two-point discrimination in the range of 10 to 15 mm. The esthetical result of the thumb was assessed as good in 13 (72%) and satisfactory in 5 patients (28%). Fifteen patients (83%), 9 blue collar workers and 6 farmers, continued with their occupations. CONCLUSION: The autograft of the amputated phalanx is a valuable reconstructive method for a selected group of patients.

[Finger transfer from contra lateral hand on metacarpal hand--case illustration]. / Transfer palca reki przeciwstawnej na reke bezpalcowa--ilustracja przypadku.

A case of reconstruction of metacarpal hand by means of ring finger transfer from contra lateral hand is presented. The patient did not accept the option of a toe transfer. The finger was implanted on the third ray. The unification of bones was done by headless AO screw resulting in an excellent bony union. The result was assessed after 11 months. Sensitivity of the transferred finger is excellent; 2-points discrimination test: 8 mm, range of motion is small--65. The cosmesis of the recipient and donor hands are excellent. No diminishing of grasp strength or of the range of finger motion of the donor hand was observed. As the result of the transfer the patient is able to perform many activities which he was unable to do preoperatively.

[Bilateral transversal humeral defect accompanied by defects of lower limbs--an attempt of improvement of upper limb's function by a reconstructive procedure, a case illustration]. / Obustronny ubytek poprzeczny ramion wspólistniejacy z niedorozwojem konczyn dolnych --próba poprawy funkcji konczyny górnej poprzez operacje rekonstrukcyjna, ilustracja przypadku.

Motor system is the most common localization of congenital defects. Disturbances of limb formation resulting in a total defect of a limb fragment are most difficult to treat. Transversal defects within the arm are usually unilateral and rarely accompanied by other congenital mutilations. The exceptional case is presented of a child with bilateral humeral transversal defect accompanied by transversal defect of a right thigh, and bilateral hip joint dysplasion. The etiology of the mutilation is unknown. The child was able to move on a wheel-chair as well as thanks to well innervated arm-stumps and a single foot to perform many activities of daily life, although some of them with a serious difficulty. The commonly stated decision was taken to operate the child aiming at improvement of limb's function. That was achieved by a reconstructive procedure creating a pincer-like enlargement of arm-stump's ending. Arm lengthening seems to be necessary in the near future.

Modified Colzi method in the management of established Volkmann contracture--the experience of Trzebnica Limb Replantation Center (preliminary report).

BACKGROUND: "The terrible disability of irreversible ischaemic flexion contracture of the metacarpi and digits known as Volkmann's contracture can be avoided in the vast majority of cases, but never completely cured" (M. Koszla). A modification of Colzi's forgotten technique for the treatment of Volkmann's contracture is presented together with our treatment outcomes. MATERIAL AND METHOD: The Colzi procedure was performed in 15 patients aged: 3-54 years with Buck-Gramcko grade III, III/IV and IV Volkmann's contractures. Time between injury and surgery ranged from 4.5 months to 21 years. The main manoeuvre to reduce the contracture was two-level shortening osteotomy in the proximal and distal thirds of the radius and ulna. Osteosynthesis was performed by Rush intramedullary nailing. RESULTS AND CONCLUSIONS: A very good range of mobility (from 17 degrees preop. to 56 degrees postop.), force (0.73 preop.- 7.6 kg postop.) and contracture correction (183 degrees preop. - 27 degrees postop.) was achieved. Complications in the form of delayed union or secondary fractures occurred in 4/15 patients, and were managed by prolonged immobilisation and decortication with bone grafting. The modified Colzi procedure proved its value as a universal, easy, minimally invasive and safe method of treatment of Volkmann's contracture regardless of patient age, duration of illness, previous therapy, and stage of contracture.