Functional and socioprofessional outcome of surgery for Volkmann's contracture.

OBJECTIVES: Volkmann's ischemic contracture is rare and surgical treatment remains a challenge. The goal of treatment is to obtain permanent recovery of joint range of motion and strength. The goal of this study was to evaluate the functional and socioprofessional outcome of surgical treatment of Volkmann's ischemic contracture. METHODS: This retrospective study was performed in two centers with one surgeon. Seven patients were included; mean age 23.6 years old. The Quick-Dash score, Patient Rated Wrist Questionnaire (PRWE) scores were obtained. Grip strength was compared to the contralateral side. Satisfaction was evaluated by the question: would you have surgery again? The surgical technique included 7 muscle slide procedures. RESULTS: Wrist and finger range of motion was good at least 6.1years in all cases according to the system by Buck-Gramcko. Grip strength on the operated side was 72.3% of the contralateral side. The mean PRWE was 14.64/100, mean QUICK-DASH score was 7.9/100. Patients returned to their professional activities in all cases. Patients who were questioned were all satisfied with surgery. CONCLUSIONS: Once the contracture is established in Volkmann's contracture Page-Scaglieti-Gosset muscle slide procedure can be used with good results allowing a return to socioprofessional activities. LEVEL OF EVIDENCE: IV, retrospective study.

Localized type Volkmann's contracture treated with tendon transfer and tension-reduced early mobilization: A case report.

RATIONALE: For localized type Volkmann's contracture, in which degeneration of the flexor digitorum profundus (FDP) muscle to one or two fingers and restriction of finger extension occur, dissection or excision of the affected muscle is usually recommended. However, these surgical procedures need relatively wide exposure of the muscle, because the FDP muscle is in the deep portion of the forearm. PATIENT CONCERNS: In this report, the case of a 35-year-old woman with localized type Volkmann's contracture is presented. Her left forearm had been compressed with an industrial roller 4 months earlier, and severe flexion contracture of the long finger and mild flexion contracture of the ring finger developed gradually. DIAGNOSES:: localized type Volkmann's contracture. INTERVENTION: Five months after the injury, transection of the FDP tendon to the long finger and transfer of the transected tendon to the FDP tendon to the index finger was performed after adjusting the tonus of these two tendons using a small skin incision. This procedure was followed by a tension-reduced early mobilization technique in which a tension-reduced position of the tendon suture site was maintained by taping the long finger to the volar side of the index finger, and then immediate active range of motion (ROM) exercise was started. OUTCOMES: Within 9 weeks after surgery, full ROM had been regained. LESSONS: Using the treatment procedure presented in this case report, a good clinical result was obtained in a minimally invasive manner.

Mechanisms of myocardial ischemia-reperfusion injury and the cytoprotective role of minocycline: scope and limitations.

Deep insight into the complex mechanisms of myocardial ischemia-reperfusion injury has been attained in the past years. Minocycline is a second-generation tetracycline with US FDA approval for clinical use in various infections. Lately, several noninfectious cytoprotective activities of minocycline have been discovered as well. There now exists encouraging evidence of its protective role in cardiovascular pathology and its activity against myocardial ischemia-reperfusion injury. In this article, an overview of the major mechanisms involved in myocardial ischemia-reperfusion injury is presented. This is followed by an analysis of the mechanisms by which minocycline exerts its cytoprotective role and of studies that have been conducted in order to analyze minocycline, along with a review of the scope and limitations of its role as a cytoprotective agent.

Free myocutaneous flap transfer to treat congenital Volkmann's contracture of the forearm.

The purpose of this study is to report our experience with free functional muscle transfer procedures for the late sequelae of the rare condition of congenital Volkmann's ischaemic contracture of the forearm. Four children, with an average age of 9.5 years (range 1.5-17), were treated and were followed for a mean of 6 years (range 1-14). Two patients had dorsal forearm contractures, and two had both flexor and extensor forearm contractures. We carried out free functional muscle transfers to replace the flexor or extensor muscles. The functional result was assessed according to the classification system of Hovius and Ultee. All patients had wrist contractures and skeletal involvement with limb length discrepancy that influenced the outcome. All five transferred muscles survived and improved the function of the hand in three of the four patients. LEVEL OF EVIDENCE 4.

[Functional diagnosis of the foot ischemic contracture].

Correlation analysis between severity of the foot ischemic contracture (FIC) and the degree of its function disorder was conducted. The 100-point scale of H. B. Kitaoka was applied for investigation of functional disorders, the FIC severity was estimated according to A. P. Lyabakh, S. S. Strafun (1994) classification. The results obtained have witnessed the dependence of the foot functional state in a residual state from the ischemia severity, what is confirmed by Cruscal - Wallice and Dann criteria. Low indices in patients with a mild B and moderate A FIC severity were caused by impact of some factors, which were noncontrolled by the system of the point estimation, including such as the ischemic affection of own foot muscles.

Calcific myonecrosis of the upper extremity: case report.

Calcific myonecrosis is an uncommon late sequela of limb trauma that results in calcification and necrosis of damaged muscle. It almost exclusively occurs in the lower extremity. We present a second case of calcific myonecrosis in the upper extremity.

Functional reconstruction of ischemic contracture in the lower limb.

OBJECTIVE: To discuss the method of functional reconstruction of ischemic contracture in the lower limb and propose a classification protocol for ischemic contracture in the lower limb based on its severity and prognosis. METHODS: A total of 42 patients with ischemic contracture in the lower limb were included in this study. According to different types of disturbance and degrees of severity, surgical reconstructions consisting of nerve decompression, tendon lengthening or transfer, intrinsic foot muscle release and sural-tibial nerve anastomosis were performed in every patient. RESULTS: Postoperatively, all patients were able to walk on flat ground. Drop foot was corrected in 10 patients, and 5 patients still felt some difficulty during stair activity. Split Achilles tendon transfer to flexor hallucis longus tendon was performed in 12 patients, and their walking stability was improved. Seven patients accepted ipsilateral sural-tibial nerve anastomosis, and sensitivity recovery reached to S2 in 2 patients and S3 in 5 patients. CONCLUSIONS: Ischemic contracture in the lower limb is a devastating complication after lower limb trauma. The prevention of contracture is much more important than the treatment of an established contracture. Split Achilles tendon transfer to flexor hallucis longus tendon and sural-tibial nerve anastomosis, which was initially implemented by us, could improve the functional recovery of ischemic contracture in lower limbs, and thus provides a new alternative for functional reconstruction of ischemic contracture in the lower limb.

[Functional and morphologic changes in the tendons and multimicrovacuolar collagen absorbing system of the three-phalanx fingers in disorder of arterial inflow].

Taking into account the fact, that unsatisfactory results of treatment of the thumbs traumatic damage are significantly caused by presence of anatomic disruption of the thumbs palm's own arteries with chronic tissue ischemia occurrence. One of consequences of damage of the three-phalanx thumbs interphalanx joints and the thumbs palm's own arteries is a formation of quickly progressing secondary flexing contracture of proximal interphalanx joints (PIPHJ). In the investigations accomplished there was established, that the changed tissues of the flexors tendons and their sheaths, forming cicatricial blockade distally to the primary trauma site, are taking part in a PIPHJ contracture development while arterial perfusion presence.The tissues damage severity, as well as a severity of clinical features of the tendons and their sheaths damage, depends on a degree of an arterial perfusion disorder present,

[Clinical and experimental assessment of the current treatment of tibial shaft fractures]. / Lábszártörés korszerû kezelésének értékelése klinikai és kísérletes vizsgálatokkal.

Tibial shaft fractures present 15% of all fractures, which means about 2500 cases per year in Hungary. 90% of these fractures are treated surgically. Nowadays, the incidence of tibia fractures is increased, the severity of the fractures is intensified and in spite of new surgical techniques the rate of complications is not dramatically decreased. The treatment of the open tibia fractures has basically changed since the introduction of unreamed intramedullar nails. The unreamed nails turned into the primary method in the treatment of the Grade II and III open fractures and became sufficient for the fixation of the proximal and distal third tibia fractures. In Hungary, we used the Marchetti-Vicenzi nail for the treatment of tibia fractures in first time, with this method the tibial shaft and distal part fractures can be treated safely with low rate of complication. In year 1997 we prepared the treatment concept of the combination of the dynamic brace and the undreamed intramedullar nail. We proved that by the application of this method the advantages of the two treatment form could be attached and the healing period and the rehabilitation of the injured could be shortened. During the clinical exploration of the complications we proved that different pressure levels developed in the muscular compartment around the tibia during the usage of two different surgical techniques, the reamed and unreamed nailing. In the deep compartment we measured statistically higher pressure in the cases of unreamed nailing. In contrast to the literature we can draw the conclusion that there is no relationship between the compartmental pressure changes, the chance of the development of compartment syndrome and the insertion technique of the intramedullar nails. In pursuance of the basic research of the complications we investigated the muscle samples from compartment syndrome and from Volkmann ischemic contracture with differential scanning calorimetry. We proved that there is a difference between thermal features of the intact and ischemic muscles. We demonstrated that there is a close correlation between the compartmental pressure, the structural damage of muscle tissues and thermo-chemic values measured by calorimetry. Due to their sensitivity and specificity, calorimetric examinations can help and support the clinical diagnosis in atypical cases.

[Review of Volkmann's ischaemic contracture]. / Attekintés a Volkmann-féle ischaemiás kontraktúráról.

The author calls the attention, with reference to the four cases observed lately, to the reappearence of the Volkmann's ischaemic contracture, which was described at the end of the 19th century, but has been almost forgotten with the developing of traumatology. It discusses the reasons of development, the results and the treatment possibilities of the illness. It emphasizes that a non-diagnosed or non-recognised forearm compartment syndrome which has been mistreated, can cause a symptom collection of different seriousness, which reduces the function of the hands considerably and which is difficult to handle. Prevention is considered to be the most important. It suggests that only an experienced specialist, who is familiar with hand surgery, should treat the developed contracture. It reveals that, differently from the classical way of its developing, nowadays the other etiological contractures are coming to the front. Therefore the important point is that not only the trauma surgeons but also the representatives of other disciplines should be aware of the rare syndrome which has serious consequences.

Ischemic preconditioning of the whole heart confers protection on subsequently isolated ventricular myocytes.

Current cellular models of ischemic preconditioning (IPC) rely on inducing preconditioning in vitro and may not accurately represent complex pathways triggered by IPC in the intact heart. Here, we show that it is possible to precondition the intact heart and to subsequently isolate individual ventricular myocytes that retain the protection triggered by IPC. Myocytes isolated from Langendorff-perfused hearts preconditioned with three cycles of ischemia-reperfusion were exposed to metabolic inhibition and reenergization. Injury was assessed from induction of hypercontracture and loss of Ca(2+) homeostasis and contractile function. IPC induced an immediate window of protection in isolated myocytes, with 64.3 +/- 7.6% of IPC myocytes recovering Ca(2+) homeostasis compared with 16.9 +/- 2.4% of control myocytes (P < 0.01). Similarly, 64.1 +/- 5.9% of IPC myocytes recovered contractile function compared with 15.3 +/- 2.2% of control myocytes (P < 0.01). Protection was prevented by the presence of 0.5 mM 5-hydroxydecanoate during the preconditioning stimulus. This early protection disappeared after 6 h, but a second window of protection developed 24 h after preconditioning, with 54.9 +/- 4.7% of preconditioned myocytes recovering Ca(2+) homeostasis compared with 12.6 +/- 2.9% of control myocytes (P < 0.01). These data show that "true" IPC of the heart confers both windows of protection in the isolated myocytes, with a similar temporal relationship to in vivo preconditioning of the whole heart. The model should allow future studies in isolated cells of the protective mechanisms induced by true ischemia.