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Published in Anton Sebastian, A Dictionary of the History of Medicine, 2018
Volkmann Contracture In fingers and wrists following ischemia secondary to injury at the elbow or improper application of tourniquet. Described in 1881 by a German surgeon, Richard von Volkmann (1830–1889), professor of surgery at Halle. He also identified industrial tar and paraffin as carcinogens in 1875 and performed an excision of the rectum for cancer in 1878.
The ankle and foot
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
In pes cavus the arch is higher than normal, and often there is also clawing of the toes. The close resemblance to deformities seen in neurological disorders where the intrinsic muscles are weak or paralyzed suggests that all forms of pes cavus are due to some type of muscle imbalance. There are rare congenital causes, such as arthrogryposis, but in the majority of cases pes cavus results from an acquired neuromuscular disorder (see Box 21.1). A specific abnormality can often be identified; hereditary motor and sensory neuropathies and spinal cord abnormalities (tethered cord syndrome, diastematomyelia) are the commonest in Western countries but poliomyelitis is the most common cause worldwide. Occasionally the deformity follows trauma such as burns or a compartment syndrome resulting in Volkmann’s contracture of the muscles in the sole.
Pediatric vascular trauma
Published in David E. Wesson, Bindi Naik-Mathuria, Pediatric Trauma, 2017
Vasospasm frequently overlaps with true arterial injuries, and often clouds the diagnosis. Angiography does not help determine which patients would benefit from revascularization [98]. Valentine et al. explored 12 “pink pulseless hands” that persisted after SCH reduction, and found eight focal brachial artery thromboses. These were repaired with focal thromboectomy, short segment bypass, and angioplasty. Four of 12 brachial arteries were simply entrapped with the median nerve, with resumption of normal patency after lysis of the bands that were entrapping the brachial artery [99]. Long-term outcomes appear excellent. In a separate series of 12 “pink-pulseless” extremities after SCH, there was 100% patency of arterial reconstructions after a mean follow-up of 14 years [98]. The authors tend to favor exploration for “pink pulseless hands” after reduction of SCH, though data regarding the conservative management of this pathology remain unclear. This is due to the excellent reported durability of repairs, with minimal associated morbidity. Moreover, while complications such as limb-length discrepancy and Volkmann’s contracture are extremely rare, they are devastating and difficult to treat. Repairs include patch angioplasty, interposition grafting, primary repair, and lysis of constrictive bands. After repair, nitroglycerin is applied to alleviate vasospasm and Doppler signals are reassessed. In the authors’ experience, completion intraoperative ultrasound is a helpful adjunct to assess that the quality of the repair is excellent.
9 years’ follow-up of 168 pin-fixed supracondylar humerus fractures in children
Published in Acta Orthopaedica, 2018
Noora Tuomilehto, Antti Sommarhem, Aarno Y Nietosvaara
Volkmann’s contracture and permanent iatrogenic nerve injuries can be regarded as complications of treatment and their prevalence should be zero (Vallila et al. 2015). We consider a deep infection rate of less than 1% acceptable. Flynn’s criteria are generally used in order to assess the quality of treatment regarding elbow ROM and CA (Flynn et al. 2015). During the study period in 2002–6, the rate of Volkmann’s contracture was zero, and the risk of deep infection and permanent treatment-related nerve complications was low (< 1%) at our institution.