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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Reporting 14 own cases symptomatology and treatment of the common ischemic syndromes of the extremities (Volkmann's contracture, thumb adduction contracture respectively contracture of the intrinsic hand muscles and anterior tibial syndrome) including the regularly concomitant nerve lesions are discussed. Edema and compression beyond the primary ischemia are essential factors in pathogenesis of nerve and muscle lesions. The electromyographic examination is helpful in diagnosis, prognosis and treatment of the severe sequelae of nerve and muscle. Since late diagnosis yields poor therapeutical results, early recognition of ischemic states and prophylaxis are most important.
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PMID:[Ischemic contractures of muscle and nerve lesions (author's transl)]. 17 1

Fifteen upper extremities, in 14 patients in whom incipient or actual Volkmann's ischemic contracture was present, were seen in a 5 year period. Nine patients were stuporous due to drug overdose and had laid on the extremity; two had received a recent injury of main arterial trunks; two had sudden severe compression; one with chronic myelogenous leukemia had each arm involved at different times in a bizarre autoimmune response causing massive swelling. No patient had a fracture or dislocation. Pain and tenderness, loss of sensibility, resistant muscle contracture, and rock-hard muscle compartments were warning signs. Immediate fasciotomy was done. Useful function was restored when treatment was carried out in the early stages of the ischemia.
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PMID:Volkmann's ischemic contracture due to soft tissue injury alone. 101 90

We report five cases of children born with forearm wounds associated with motor and sensory losses to the hand and forearm. Their evolution toward muscle retraction is very similar to the classic description of Volkmann's ischemic contracture. These cases should not be confused with upper extremity gangrene of the newborn or aplasia cutis congenita. Two cases of neonatal Volkmann's ischemia have already been reported in the literature and identified as such. Another very similar case has been reported as upper extremity gangrene of the newborn, and three more cases of a forearm wound with neuromuscular involvement have been reported as aplasia cutis congenita. We believe that neonatal Volkmann's ischemic contracture of the forearm should be recognized as a separate entity. Its early diagnosis may improve treatment, especially for children with recent injury, in whom intracompartmental pressures may still be elevated. Early hand therapy and splinting are mandatory to minimize late sequelae.
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PMID:Neonatal Volkmann's ischemic contracture of the forearm: a report of five cases. 140 98

The multiple contributory aspects of the claw deformity seen in 115 cases of established Volkmann's contracture has been analyzed. This has given rise to a clinically oriented 5-Stage classification. Clinical and electrical motor nerve deficits in the median, ulnar and radial distributions have shown considerable variability between patients. The individual pattern of nerve damage has been outlined. The measurement of passive extension deficits (PED) illustrates the degree of extrinsic muscle contracture. The PED is increased proportionally to nerve damage. Secondary stigmata of chronic ischemia (ie chronic changes, sensory deficits,stiff joints, web-space and intrinsic contractures) are increased proportionally to muscle and motor nerve damage. Staging in these five groups has permitted the establishment of rapid diagnosis, severity of injury, prognostic evaluation and management modalities according to stage.
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PMID:Proposal of a new classification for established Volkmann's contracture. 402 28

Fibrotic contracture of skeletal muscle can follow weeks or months after the severe ischemic insult of compartment syndrome. Commonly known as Volkmann's ischemic contracture, the affected limb often becomes dysfunctional and painful, and may lose sensibility. The pathogenesis of the muscle contracture includes prolonged ischemia, myonecrosis, fibroblastic proliferation, contraction of the cicatrix, and myotendinous adhesion formation. Resultant shortening or overpull of involved muscles leads to stiffness and deformity. Simultaneously, nerve injury from initial ischemia or subsequent soft tissue fibrotic compression leads to muscle paresis or paralysis of the involved compartment and of those muscles more distally innervated. The resultant deformity is thus a combination of varying degrees of contracture and weakness depending on which muscles and nerves are affected. Deformity and functional impairment in the foot and ankle secondary to ischemia are determined by many factors, including: (1) which leg compartment, if any, has been affected and to what degree extrinsic flexor or extensor overpull is exhibited, (2) degree of nerve injury sustained causing weakness or paralysis of extrinsic or intrinsic foot and ankle muscles (3) which foot compartment, if any, has been affected and to what degree intrinsic overpull is exhibited, and (4) degree of sensory nerve injury leading to anesthesia, hypoesthesia, or hyperesthesia of the foot. Therefore, a variety of clinical presentations can be encountered following compartment syndrome of the leg and foot. Treatment is based on an appreciation of the pathoanatomy of the deformity. Nonoperative therapy is aimed at obtaining or preserving joint mobility, increasing strength, and providing corrective bracing and accommodative footwear. Operative management is usually reserved for treatment of residual nerve compression or severe and problematic deformities. Established surgical protocols are performed in a stepwise fashion, to include: (1) release of residual or secondary nerve compression, (2) release of fixed contractures, using infarct excision, myotendinous lengthening, muscle recession, or tenotomy, (3) tendon transfers or arthrodesis to increase function, and (4) ostectomy or amputation for severe, refractory deformities.
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PMID:Volkmann's ischemic contracture of the foot and ankle: evaluation and treatment of established deformity. 755 Sep 46

Between 1988 and 1994, 128 consecutive children with grade III supracondylar humeral fractures presented for treatment at our hospital. Seventeen had absent or diminished (detected with Doppler but not palpable) radial pulses on initial examination. Fourteen of these 17 children recovered pulse (palpable) after reduction and stabilization of their fractures. The remaining three had persistent absence of radial pulse. Each of these three children was explored immediately and found to have a significant vascular injury requiring repair. Two of the 14 children who had initially regained their pulses had a progressive postoperative deterioration in their circulatory status during the first 24-36 h, including loss of the radial pulse. Both of these children had arteriograms that identified vascular injuries. Both underwent exploration and bypass grafting. One of these two children had been transferred 48 h after injury, resulting in delay of management of his vascular impairment. Despite exploration, vascular repair, and fasciotomy, he ultimately developed Volkmann's ischemic contracture. All five children with significant vascular injuries had absent or diminished radial pulses on presentation. Immediate reduction and fixation followed by careful evaluation and treatment of ischemia were associated with excellent outcome in four of the five children.
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PMID:Vascular injuries and their sequelae in pediatric supracondylar humeral fractures: toward a goal of prevention. 874 64

The arterial blood supply of the arm is unique, as the collateral circulation is especially good. Because of this anatomic perculiarity it is possible to deal with lack of peripheral pulse without critical ischemia occurring in fractures in the elbow region. We present two children with supracondylar fractures of the humerus with damage to the brachial artery and the different management results. It is necessary to carry out the immediate diagnostic and therapeutic procedures in order to prevent late complications. We conclude that Volkmann's ischemic contracture can always be prevented.
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PMID:[Compartment syndrome and Volkmann contracture--can they be prevented in supracondylar humerus fracture?]. 986 38

It may be concluded that treatment of patients with Volkmann's ischemic contracture is complicated and depends on a number of different variables. Optimal treatment of an established contracture requires a through examination of the extent of damage of the ischemia, followed by conservative therapy or operation. The most important measures concerning Volkmann's ischemic contracture, however, involve measures to prevent the contracture. It is poignant that very simple measures, such as monitoring high-risk injuries and immediate vascular repair or decompression if symptoms of a compartment syndrome are present, can prevent this disabling condition. The following summaries hopefully provide guidelines for prevention and treatment of Volkmann's ischemic contracture.
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PMID:Volkmann's ischemic contracture. Prevention and treatment. 1111 54

As with many diagnoses in medicine, the best treatment for Volkmann's ischemic contracture is prevention. Early recognition and prompt treatment of impending Volkmann's ischemia should decrease the presentation and severity of late contracture and hand dysfunction. The authors have found the flexor muscle slide the best treatment option for mild and moderate deformity. This procedure can be combined with additional reconstructive procedures to maximize functional outcome. The authors believe this procedure results in the best preservation of the muscle resting length and limits the scarring around the adjacent muscles. For severe cases,early wide excision with functional free-muscle transfer may limit the injury to the nerves, decreasing the distal problems associated with mo-tor and sensory impairment in the hand.
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PMID:Management of established Volkmann's contracture of the forearm in children. 1650 82

In the aftermath of a forearm trauma, tendon contractures are difficult to diagnose and evoke nerve compression or muscle ischemia (Volkmann's syndrome). One rarely thinks of tendon incarceration within the fracture and the diagnosis is often made long after. During claw fingers retraction, it is known as "false Volkmann's syndrome" (Baudet and Lafond, 1979) or "pseudo Volkmann's syndrome" (Deeney et al., 1998). The authors report the case of ulnar claw fingers retraction, one year after a fracture of both bones of the forearm, treated surgically with recuperation of normal mobility immediately after emergence of the conflict.
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PMID:[Tendon entrapment after forearm distal bones fracture, case report]. 2185 1


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