Diagnosis and treatment of finger flexion contracture caused by forearm flexor disease / 中国修复重建外科杂志

OBJECTIVE@#To summarize the clinical characteristics, differential diagnosis, and treatment methods of finger flexion contracture caused by three kinds of forearm flexor diseases.@*METHODS@#Between December 2008 and August 2021, 17 patients with finger flexion contracture were treated, including 8 males and 9 females, aged 5-42 years, with a median of 16 years. The disease duration ranged from 1.5 months to 30 years, with a median of 13 years. The etiology included 6 cases of Volkmann's contracture, all of which were flexion deformity of the 2nd to 5th fingers, accompanied by limitation of thumb dorsiflexion in 3 cases and limitation of wrist dorsiflexion in 3 cases; 3 cases of pseudo-Volkmann's contracture, including 2 cases of flexion deformity of middle, ring, and little fingers, and 1 case of flexion deformity of ring and little fingers; 8 cases of ulnar finger flexion contracture caused by forearm flexor disease or anatomical variations, all of which were flexion deformity of middle, ring, and little fingers. Operations such as slide of flexor and pronator teres origin, excision of abnormal fibrous cord and bony prominence, and release of entrapped muscle (tendon) were performed. Hand function was evaluated according to WANG Haihua's hand function rating standard or modified Buck-Gramcko classification standard, and muscle strength was evaluated according to British Medical Research Council (MRC) muscle strength rating standard.@*RESULTS@#All patients were followed up 1-10 years (median, 1.5 years). At last follow-up, 8 patients with contracture caused by forearm flexor disease or anatomical variations and 3 patients with pseudo-Volkmann's contracture achieved excellent hand function, with muscle strength of grade M5 in 6 cases and grade M4 in 5 cases. One patient with mild Volkmann's contracture and 3 patients with moderate Volkmann's contracture without severe nerve damage had excellent hand function in 2 cases and good in 2 cases, with muscle strength of grade M5 in 1 case and grade M4 in 3 cases. Two patients with moderate or severe Volkmann's contracture had poor hand function, with 1 case of muscle strength of grade M3 and 1 case of grade M2, which improved when compared with those before operation. The overall excellent and good rate of hand function and the proportion of patients with muscle strength of grade M4 and above were 88.2% (15/17), respectively.@*CONCLUSION@#The finger flexion contracture caused by different etiology can be differentiated by analyzing the history, physical examination, radiographs, and intraoperative findings. After different surgical treatments, such as resection of contracture band, release of compressed muscle (tendon), and downward movement of flexor origin, most patients have a good outcome.

Effect of pralidoxime on coronary perfusion pressure during cardiopulmonary resuscitation in a pig model

OBJECTIVE: Pralidoxime is widely used for the treatment of organophosphate poisoning. Multiple studies have reported its vasoconstrictive property, which may facilitate the restoration of spontaneous circulation (ROSC) after cardiac arrest by increasing the coronary perfusion pressure (CPP). 2,3-Butanedione monoxime, which belongs to the same oxime family, has been shown to facilitate ROSC by reducing left ventricular ischemic contracture. Because pralidoxime and 2,3-butanedione monoxime have several common mechanisms of action, both drugs may have similar effects on ischemic contracture. Thus, we investigated the effects of pralidoxime administration during cardiopulmonary resuscitation in a pig model with a focus on ischemic contracture and CPP.METHODS: After 14 minutes of untreated ventricular fibrillation, followed by 8 minutes of basic life support, 16 pigs randomly received either 80 mg/kg of pralidoxime (pralidoxime group) or an equivalent volume of saline (control group) during advanced cardiovascular life support (ACLS).RESULTS: Mixed-model analyses of left ventricular wall thickness and chamber area during ACLS revealed no significant group effects or group-time interactions, whereas a mixed-model analysis of the CPP during ACLS revealed a significant group effect (P=0.038) and group-time interaction (P<0.001). Post-hoc analyses revealed significant increases in CPP in the pralidoxime group, starting at 5 minutes after pralidoxime administration. No animal, except one in the pralidoxime group, achieved ROSC; thus, the rate of ROSC did not differ between the two groups.CONCLUSION: In a pig model of cardiac arrest, pralidoxime administered during cardiopulmonary resuscitation did not reduce ischemic contracture; however, it significantly improved CPP.

Free Functioning Muscle Transfer in Brachial Plexus Injury

The free functional muscle transfer (FFMT) is the surgical procedure aimed at reconstructing defective or deteriorated muscle function by grafting free muscles including blood vessels and nerves. Since the free gracilis transfer in the facial paralysis was introduced in 1976, there have been many studies and clinical applications of the FFMT in various donor and recipient sites in brachial plexus injury, muscle ischemic contracture, muscle defect after tumor resection, congenital muscular deficit, multiple trauma. When the reconstruction of the nerve is delayed for 9 months to 1 year after the brachial plexus injury, voluntary muscle contracture is impossible even after the nerve regeneration by the irreversible degeneration of the muscles. And it is difficult to obtain adequate function even if nerve transfer or nerve transplantation is performed because the distance to be regenerated is too long. In these cases, the FFMT has been improved the functions of the upper limb in flexion or extension of the elbow, fingers. Many good clinical results of the FFMT have been reported, so the FFMT gets much interests and attentions. The essential things for the successful outcome of the surgery are the anatomical knowledge, the skilled surgical technique and the choice of patients who can meet the indications and receive long-term rehabilitation. Recent advances in surgical techniques will result in improved results of the FFMT.

Peripheral Transluminal Angioplasty for Limb Salvage in Critical Limb Ischemia in an Old Cerebral Infarction with Multiple Contractures / 대한내과학회지

Percutaneous transluminal angioplasty is being used to treat peripheral artery disease increasingly in place of conventional peripheral vascular surgery. Critical limb ischemia is the most severe form of peripheral artery disease and presents with ischemic resting pain and non-healing foot wounds or gangrene. It can result in amputation and increased mortality if aggressive revascularization to obtain sufficient blood is not performed as soon as possible. Generally, both femoral arteries are used for vascular access. However, we could not use the femoral artery for vascular access in a patient with multiple contractures of the extremities due to an old cerebral infarction. Consequently, we used the left brachial artery to perform successful revascularization of the left foot in critical limb ischemia.

Closed treatment for type III humeral supracondylar fractures and prevention of ischemic contracture of forearm in children / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the curative effects of manipulative reduction for children's type III humeral supracondylar fracture and the preventions of ischemic contracture of forearm in the early period.</p><p><b>METHODS</b>From September 2008 to September 2011, 38 patients with humeral supracondylar fractures were treated with manipulative reduction and plaster stabilization, including 20 males and 18 females with an average age of 7.5 years (ranged, 2 to 13 years); the average time from injury to visit was 1.8 days(ranged,0.5 h to 6 d). There were 21 cases in straighten-ulnar deviation type and 17 cases in straighten-radial deviation type, 1 case in flexion type,all of them without vascular nerve injury. It was important to process swelling correctly in early stage of fracture. To decide fixed position according to the original displacement, and make a regular X-ray review, if found another displacement to correct it in 1-2 weeks after injury in time. Dismantle the plaster on the basis of bone healing and guide the functional exercise of elbow joint. According to Dodgt standard to evaluate clinical effects.</p><p><b>RESULTS</b>All patients were followed up from 3 months to 1 year with an average of 7 months. All fractures healed. According to Dodgt standard, 14 patients got an excellent results, 19 good, 4 fair and 1 poor. The excellent and good rate was 86.84%.</p><p><b>CONCLUSION</b>It can obtain satisfactory clinical effects to treat humeral supracondylar fracture in children with closed manipulative reduction and plaster stabilization, while without vascular nerve injury. Early correct processing swelling and paying attention to gypsous angle can effectively prevent the ischemic contracture of forearm.</p>

[Volkmann's syndrome]

Background and Aim: The volkmann syndrome is ischemia and muscular necrosis due to pressure augmentation in the closed aponeurotic compartments of the forearm region. The incidence of this syndrome in Iran is more than the normal incidence, since non-medical people perform bandage or casting too tightly, for the treatment of forearm lesions

Materials and Methods: A total of 67 patients, 64 male and three female, ranging in age from 7 to 18 years with the average of 13 years were treated by one of the four methods of Scaglietti, Latissimus dorsi Island flap, Gracilis free muscle transfer or Biceps tendon transfer

Results: From 33 patients with some muscle contracture who underwent flexor muscle advancement [Scaglietti technique] 25 [71.4%] resulted in excellent, and 10 [28.6%] resulted in good outcome. Latissimus dorsi Island flap resulted in 20 [90.9%] excellent, and 2 [9.1%] good results in total of 22 patients. Gracilis muscle transfer in 4 patients resulted in 4 good outcomes [100%]. Six biceps tendon transfer procedure resulted in 6 good outcomes [100%]

Conclusion: If some forearm muscle contraction is revealed in the physical examination, good results can be obtained by performing the Scaglietti procedure. We did not have any muscle necrosis of the transferred latisimuss dorsi island flap, or musculocutaneous gracillis free flaps transferred. The transfer of biceps tendon to the digital flexor tendon yields in acceptable results for the patients. But the patient needs good re-education and physiotherapy for adaptation to the new condition

Functional reconstruction of ischemic contracture in the lower limb / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>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.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSIONS</b>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.</p>

Features of ischemic myocardial contracture after asphyxia-induced cardiac arrest in rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the features of ischemic myocardial contracture after asphyxial cardiac arrest in rats.</p><p><b>METHOD</b>Asphyxial cardiac arrest was induced in 8 Wistar rats, and the length and width of the heart were measured at the different time points after cardiac arrest.</p><p><b>RESULTS</b>Obvious ischemic myocardial contracture occurred after the cardiac arrest, reaching the maximal contracture at 4-6 min after the arrest.</p><p><b>CONCLUSIONS</b>Ischemic myocardial contracture induced by asphyxia may be an important factor affecting the outcome of cardiopulmonary resuscitation.</p>

Cirugía de salvamento de extremidad: el cirujano vascular versus la amputación mayor / Limb salvage surgery: the vascular surgeon versus major amputation

Este trabajo prospectivo muestra cómo entre marzo de 2001 y mayo de 2004 se manejaron siete pacientes que consultaron al Hospital de San José y la Clínica Fundadores en la Ciudad de Bogotá, Colombia, con lesiones isquémicas en el pie secundarias a oclusión aterosclerótica de las arterias infrapoplíteas. Dos de ellos cursaron con insuficiencia renal crónica, cuatro eran diabéticos y uno fumador durante varios años. El examen físico reveló lesiones isquémicas localizadas en el pie y pulso poplíteo adecuado con ausencia de pedio y tibial posterior. A todos se les realizó estudio arteriográfico mediante técnica de Seldinger, en el cual se confirmó oclusión de las arterias infrapoplíteas. Todos fueron llevados a exploración quirúrgica bajo anestesia regional, encontrando en cuatro de ellos buen lecho receptor a nivel de la arteria pedia, por lo que se les realizó injerto poplíteo-pedio con safena invertida, y en los tres restantes buen lecho a nivel de la arteria tibial posterior, por lo que se les practicó injerto poplíteo-tibial también con safena invertida. Después se procedió a desbridamiento de las áreas necrosadas. El seguimiento postoperatorio mostró que en los pacientes a los que se realizó injerto poplíteo-tibial hubo fracaso de los mismos, dos por infección del injerto y otro por oclusión recurrente. En ninguno de ellos se logró cicatrización de las lesiones del pie y por último uno requirió amputación infracondílea y dos supracondílea. En aquellos en los que se revascularizó la arteria pedia, se apreció permeabilidad adecuada del injerto con una cicatrización total de las áreas desbridadas al cabo de 90 días con recuperación de la marcha y funcionalidad total de la extremidad. Se concluye que en estos enfermos se debe siempre intentar algún procedimiento de revascularización y es la exploración quirúrgica la que en últimas define esta posibilidad, que si bien no siempre es efectiva, permite evitar amputaciones mayores en un número importante de casos, lo que se traduce en menor incapacidad laboral y mejor calidad de vida.

Changes in Cytosolic Ca2+ Concentration of Single Rabbit Coronary Artery Smooth Muscle Cell during Ischemic Cardioplegic Period

BACKGROUND: No-reflow is a specific type of vascular damage occuring when removal of coronary occlusion dose not lead to restoration of coronary flow. There are three major explanations for the no-reflow phenomenon such as endothelial cell edema, microvascular plugging by platelets or thrombi and coronary occlusion by ischemic contracture of the myocardium. But detailed mechanisms of no-reflow phenomenon are not known. The objects of this study are to elucidate the possibility whether elevation of cytosolic Ca2+ concentration during ischemic cardioplegic period is mechanism of no-reflow phenomenon or not. METHODS: Changes in cytosolic Ca2+ concentration were measured under varying experimental condition. Free [Ca2+] in the cytosole [Ca2+]i of single rabbit coronary artery cells was measured with fluorescent Ca2+ indicator, Fura-2. RESULTS: Resting [Ca2+]i was 134.2+/-34 nM (n=43). When single cells were perfused with cardioplegic or ischemic cardioplegic solution, [Ca2+]i was significantly increased and degree of [Ca2+]i elevation was further augmented by ischemic cardioplegic solution. Pretreatment of sarcoplasmic reticulum emptying agent (20mM caffeine) had no effect on cardioplegia-induced [Ca2+]i change, but application of Ca2+ channel blocker (5x10-7M nifedipine) or an antagonist of Na+/Ca2+ exchange (5mM Ni2+ ) partially (nifedipine) or completely (nickel) inhibited the [Ca2+]i elevation. Pretreament of caffeine had no effect on ischemic cardioplegia-induced [Ca2+]i change, but application of nifedipine or nickel partially inhibited the [Ca2+]i elevation. Magnitude of ischemic cardioplegia-induced [Ca2+]i elevation was dependent on the Ca2+ concentration of perfusate from 0 to 2.5mM. When Ni2+ was added to reperfusion solution, recovery of ischemic cardioplegia-induced [Ca2+]i elevation was very rapid compared with control. CONCLUSIONS: From the above results, it may be speculated that ischemic cardioplegia-induced [Ca2+]i elevation may act as one of the mechanism of no-reflow phenomenon in rabbit coronary artery.

Flexor sliding operation for established Volkmann's ischemic contracture / 대한정형외과학회잡지

No abstract available.

An Experimental Study and Clinical Investigation on Rotational Deformity in Supracondylar Fracture of the Humerus in Children / 대한정형외과학회잡지

In children, the supracondylar fractures of the humerus are common in elbow region, and often associated with various complications and problems in treatment (ie,Volkmann's ischemic contracture, cubitus valgus or varus deformity, rotational deformity). The results of reduction can be measured by Baumann's angle, carrying angle, trochlea-capitellum angle, and displacement of distal radial styloid process on radiological study. So we have made experiments on the process which various three dimensional displacements reflected into two dimensional Baumann's angle and humerocapitellar angle. And we investigated the process of rotation, through various radiological studies by means of molded models of humerus. The results were as follows:l. In experiments, AP & lateral X-ray studies showed no change in rotation of proximal segment of fracture with fixed distal segment of fracture. 2. On the other hand, AP & lateral X-ray showed significant change, in rotation of proximal fracture segment with distal segment of fracture. 3. Supracondylar rotation angle(S.R.A.)depicted as the ratio of the length of proximal fracture width minus that of the distal fracture width in lateral view, to the length of distal fracture width in AP view minus that of the distal fracture width in lateral view. 4. According to the modified Mitchell result, S.R.A. to the result of treatment was average 7.6 degree in excellent group, 15.2 degree in good group and 29.3 degree in unsatisfactory group.

Clinical Studies on the Supracondylar Fractures of the Humerus in Chilldren / 대한정형외과학회잡지

Supracondylar fractures of the humerus is the most common elbow fractures in children. The fractures so designated are in the supracondylar area of the humerus just proximal to the elbow, and do not directly involve the joint or the distal humeral epiphysis. Unfortunately, it can also be one of the most difficult fractures to treat. And the catastrophic picture of Volkmann's ischemic contracture and nerve injuries associated with these fractures, as after successful reduction, the late complications of loss of elbow motion, the chage in carrying angle, myositis ossifgicans, and delayed ulnar nerve palsy still lie ahead. For the period of 4 years and 10 months from May 1979 to March 1985, 47 patients who had been treated for supracondylar fractures of the humerus at the Department of Orthopaedic Surgery, college of medicine, Soon Chun Hyang University Hospital, are presented, The results obtained are as follows; 1. Supracondylar fractures of the humerus frequently occured between the ages of 4 and 9 years (70.2%) and the sex ratio was 2.1: 1 in male to female. 2. Of all fratures, 89.4% were the extension type and the left side was predominent in 55.3% than right. 3. According to the Holmberg clasification, Group 1 was 6 cases(12.8%), 10 cases(21.3%) in Group 2, 11 cases(23.4%) in Group 3, and 20 cases(42.5%) in Group 4. 4. Closed reduction with percutaneous pinning showed little changes in carrying angle. 5. Limitation of motion was most frequent complication after closed reduction with plaster cast immobilization. 6. By the modified Mitchell and Adams' criteria for grading results, excellent were obtained in 55.3 %, good in 44.7%, and zero in unsatisfactory. 7. In the neurovascular injuries associated with fractue, there were 4 neural injuries, and 2 vascular injuries. In 4 traumatic neuropathies, median nerve was involved most commonly and the were recovered spontaneously within 5 weeks. 8. Average time from injury to reduction was 1.6 day and delayed reduction or operation made worse the prognosis in most cases.

Clinical Analysis of Freee Vascular Flap / 대한정형외과학회잡지

70 cases free fiap were performed from March 1978 to July 1985. The donor fiap were dorsalis pedis flap in 34 cases, groin flap in 8 cases, osteocutaeous flap in 3 cases, gracilis flap in 17 cases, and latissimus dorsi flap in 8 cases respectively. The success rate was 90% in total including partial success. The causes of failure were 2 cases infection necrosis, and 1 case kinking of drain vessel. The gracilis and latissimus dorsi myocutaneous flap were very satisfactory method for the reconstruction of the upper extremity flexion power, especially in the case of Volkmann's ischemic contracture. The neurovascular dorsalis pedis flap was regarded as excellent method for the heel pad reconstruction, and tactile sensation reconstruction of the hand.

Gracilis Myocutaneous Free Flap Transfer by Microsurgery: Report of 2 Cases / 대한정형외과학회잡지

Application of the Gracilis or Pectoralis Musculocutaneous Free Flap to restore finger fiexion after destruction of forearm flexors had been reported by a surgical team at the Six Peoples Hospital at Shanghi in 1976. Viability is maintained by microvascular anastomoses of the muscles artery and vein to a suitable artery and vein in the recipient site. Gracilis is suitable for obtaining the dynamic requirement of transplanted forarm flexors. We presented two cases of muscle transplantation using Gracilis Musculocutaneous Free Flap for the loss of function of the long flexors to digits due to Volkmanns ischemic contracture of which one was after supracondylar fracture and the other was infection after deep laceration on elbow. In both cases transplanted muscles survived but funtioning was well in one case and other case was not good due to the previous infection. In first case, excellent grip strength and nearly a full flexor finger movement was provided by transplanted muscles.

Clinical Studies on the Supracondylar Fractures of the Humerus / 대한정형외과학회잡지

Supracondylar fractures of the humerus is the most common elbow fractures in children. Many papers has been published about the treatment of the supracondylar fractures of the humerus in children and prevention of both Volkmann's ischemic contractures and nerve injuries associated with these fractures, however, unfortunately it is still one of the most difficult fractures to manage. After successful reduction, the late complications of loss of elbow motion, the change in carrying angle, myositis ossificans, and progressive ulnar nerve palsy still lie ahead. For the period of 5 years from January 1975 to December 1979, 110 patients who had been treated for supracondylar fractures of the humerus at Severance Hospital, Yonsei University Coilege of Medicine were studied and analyzed retrospectively and the results are summerized as follows: 1. The age of the patients varied from 1 to 26 years, the majority (80.0%) being between 4 to 11 years and the fractures were on the left side in 71.8% and males comprized 75.5%. 2. The extension type comprized 94.5%. 3. Most common complications were cubitus varus deformities. 4. Percutaneous pinning and open reduction and internal fixation elicited rare cubitus varus diformities. 5. Limitation of motion was most frequent camplication after open reduction and internal fixation. 6. All cases which showed cubitus varus deformities were initially medially displaced fractures. 7. Four median nerve injuries were associated with posterolateral displacement and one radial nerve injury was associated with posteromedial displacement. 8. Finally, with prompt and adequate treatment, there were no Volkmanns ischemic contractures seen in this study.

A Clinical analysis on the Fracture of the Humerus / 대한정형외과학회잡지

The cases of 128 humeral fractures were evaluated at the Department of Orthopedic Surgery, Chosun University Hospital, during the six year period from January 1974 to December 1979 and the following results were obtained. 1. The high incidence of the humeral fracture was found under the age of 30 years and the sex ratio between the male and female was 3.6:1. 2. The most common causes of injuries were fallen down on the ground (36.7%) and the nexts were traffic accidents (34.4%). 3. Among the 128 cases of fractures, humeral shaft fractures were 33 cases (32%) under the age of 40 years and 47 cases (67.1%) of supracondylar fractures under the age of 20 years and 6 cases (54.5%) of neck fractures over the age of 60 years were noted. 4. The shapes of humeral fractures found out transverse fracture in 31 cases (65.9%) and the short oblique or spiral fracture in 35 cases (71.4%). 13 cases were combined with the open would to the fracture site (10.2%). 5. In the Correlation between the age and the union rate, sound union was more rapid under the age of 20 years than the aged person. Delayed unions were revealed 5 cases in transverse fractures, 2 cases in spiral fractures and 2 cases of nonunions were experienced on both segmental and transverse fracture of the shaft (1.6%). 6. The radial nerve paralysis revealed 5 cases (10%) at the shaft fracture and 2 cases (4.3%) Volkmanns ischemic contracture, 2 cases (4.3%) of cubitus varus, 2 cases (4.3%) of cubitus valgus were experienced on the complicution in there 47 cases of supracondylar fractures.

Surgical Treatment for 3 Cases with Established Volkmann's Ischemic Contracture of the Upper Limb / 대한정형외과학회잡지

Volkmanns ischemic contracture, despite a relatively small incidence, is one of the most devastating complications following a limb injury. The orthopedic surgeon must be equipped to recognize and effectively treat this complication. Recently the authors have managed 3 cases with V.I.C. with the following results. 1) The etiology showed CO poisoning, arterial injury, wringer injury around the elbow in each case. 2) The method of surgical treatment depended upon deformities and functional loss of individual patient. 3) The end results seemed to be proportionate to the previous deformities and functional less. 4) Early postoperative passive exercises of the digits seemed to be helpful in restoring further range of motion.

Clinieal Study of 72 Cases of Supracondylar Fracture of the Humerus / 대한정형외과학회잡지

Supracondylar fracture is the most frequent injury of the elbow and frequently accompanies complications in children. Seventy two cases of supracondylar fractures have been treated and managed at Department of Orthopaedic Surgery, Catholic Medical College during the period from Jan. 1969 to Dec. 1972. The evaluation of fracture was done according to the classification of Holmberg and Hoyer. Among 72 cases of the supracondylar fracture, the most common type is 29 cases of Grade 2: (40.2%). Most cases were treated conservatively, and various method of treatment were adopted according to the condition of fracture. Residual angular deformities after successful manipulative reductiion can be accurately evaluated roentgenographically by the Baumanns method. Good results were obtained in 62.6%, fair results in 33.3%, and poor results in 4.1%. The incidence of cubitus varus deformity is 37.5%. There were no instance of ischemic contracture and no permanent neurological deficit in fracture cases.

Volkmann's Ischemic Contracture in the Lower Extremity: A Report of Three Cases / 대한정형외과학회잡지

Three cases of Volkmann's ischemic contracture in the lower extremity, which is relatively rare manifestation, are reported, One case has occurred as a complication of snake-bite, another was followed by CO intoxication and the third was caused by a direct trauma, which gave a rupture of the main artery in the thigh. The common clinical manifestation were deformity of the foot as equinus, equinovarus and cavus deformities. One case had an additional flexion contracture of the knee. One case was opearted by Achilles tendon lengthening, posterior capsulotomy of the ankle, and plantar fasciotomy, another case was operated by supracondylar osteotomy of the femur in order to correct flexion deformity of the knee followed by B-K amputation, the third was operated by triple arthrodesis of the foot with dorsal wedging.