.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.jpg)
Outcome of Max Page Muscle Sliding Operation for the Treatment of Moderate Volkmann’s Ischemic Contracture of the Forearm
Abstract
Background
Volkmann’s ischemic contracture (VIC) is a disabling condition of the extremities and is quite common condition. When this condition sets in, the prognosis is almost always guarded, despite vigorous physical therapy and a variety of reconstructive surgeries. This study was done to assess the outcome of Max Page muscle sliding operation in VIC (moderate degree) of the forearm.
Materials and methods.
A single-center retrospective review of Volkmann’s ischemic contracture patients operated between 2010 and 2018 was carried out at National Orthopedic Hospital Bahawalpur. Thirty three patients were selected meeting the inclusion criteria. The functional outcome (measured as the sensibility score and range of motion) was analyzed pre- and postoperatively. At the end of the study the results were rated as either good, fair or poor.
Outcomes.
Tight external bandages secondary to radius and ulna fracture was the main cause in majority of patients. Mean time to operation was 10.81 ±2.46 months whereas mean follow up was 13.09 ±7.60 months. By applying t-test, it was found that the improvement in sensibility score and range of motion was statistically significant (P <0.05). Twenty five patients had good functional results and eight had fair results. Postoperatively all the variables had significant improvements.
Conclusion.
The Max Page muscle sliding operation had good functional outcomes in moderate degree of Volkmann’s ischemic contractures. It is easy and simple procedure. Proper muscle release, neurolysis and good postoperative physiotherapy are important for good functional results.
Keywords: Max Page release, Volkmann’s ischemic contracture, Tight external bandage
References
Volkmann R. Die ischaemischen muskellahmungen und kontracturen. Zentralbl Chir.1881;8:801-803.
Thomas JJ. Nerve involvement in the ischemic paralysis and contracture of Volkmann. Ann Surg.1975; 57 A:925-929.
Brooks B. Pathological changes in muscle as a result of disturbances of circulation: an experimental study of Volkmann’s ischaemic paralysis. Arch Surg.1992;5:188-216.
Leriche R. Surgery of the sympathetic system: Indicators and results. Ann Surg.1928; 88:449
Griffiths DV. Volkmann’s ischaemic contracture. Br J Surg.1940;28:239-260.
Yamaguchi S, Viegas SF. Causes of upper extremity compartment syndrome. Hand Clin.1998; 14:365-370.
Seddon HJ. Volkmann’s contracture: Treatment by excision of the infarct. J Bone Joint Surg.1956; 32B:152-174.
Sharma P, Swamy KS. Results of the Max Page muscle sliding operation for the treatment of Volkmann’s ischemic contracture of the forearm.J Orthop Traumatol.2012;13(4):189-196.
Page C. An operation for the relief of flexion-contracture in the forearm. J Bone Joint Surg.1923;5:233-4.
Stevanovic M, Sharpe F. Management of Established Volkmann’s Contracture of the Forearm in Children. Hand Clin.2006; 22 :99-111.
Stevanovic M, Sharpe F. Late Management of Compartment Syndrome. In: Abzug J, Kozin S, Zlotolow D, editors. The Pediatric Upper Extremity. New York: Springer;2014.p.1-29.
Nisbet NW. Volkmann’s Ischaemic contracture benefited by muscle slide operation: Report of a Case. J Bone Joint Surg Br. 1952;34(2):245-7.
Saaiq M. Clinical and Demographic Profile of Volkmann’s Ischemic Contractures Presenting at National Institute of Rehabilitation Medicine, Islamabad, Pakistan. World J Plast Surg. 2020; 9(2): 166-173.
Tsuge K. Management of established Volkmann’s contracture.J Bone Joint Surg.1975;57A:925-929.
Sollerman C, Ejeskar A. Sollerman hand function test. A standardised method and its use in tetraplegic patients. Scand J Plast Reconstr Surg Hand Surg.1995;29(2):167-76.
Shah FA, Alam W, Durrani Z, Askar Z, Khan MA, Hayat S. Outcome of closed reduction and plaster cast immobilization of fractur distal radius in adults.Pak J Surg. 2010; 26(4):315-319.
Sundararaj GD, Mani K.Pattern of contracture and recovery following ischaemia of the upper limb. J Hand Surg Br.1985;10:155-161.
Reigstad A, Hellum C. Volkmann’s ischaemic contracture of the forearm. Injury.1980;12:148-150.
Eichler GR, Lipscomb PR. The changing treatment of Volkmann’s ischemic contractures from 1955 to 1965 at the Mayo clinic. Clin Orthop.1967;50:215-21.
Ultee J, Hovius SER. Functional results after treatment of Volkmann’s ischemic contracture: a long-term follow up study. Clin Orthop.2005; 431:42-49.
Chuang DC, Carver N, Wei FC. A new strategy to prevent the sequlae of severe Volkmann’s ischeamia. Plast Reconstr Surg.1996; 98:1023-1031.
Scaglietti O. Chirurgische Behandlung der Volkmannschen Paralyse. Verh Dtsch Orthop Ges. 1957;45:219-223.
Gosset J, La de sinsertion chirurgicale des muscles de la loge ante rieure de l avantbras dans le traitement des contractureset re actions ische miques. Ann Chir.1956; 32:509-515.
Dianming J, Hong A, Liying M. Sliding of flexor muscles for treatment of Volkmann’s contracture of the forearm. Chin J Hand Surg.1998;25-32.
