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CC BY 4.0 · European J Pediatr Surg Rep. 2022; 10(01): e68-e72
DOI: 10.1055/s-0042-1749210
Case Report

Diagnostics and Treatment of Volkmann Ischemic Contracture in a Seven-Year-Old Child

Annekatrin Schulze 
1   Department of Pediatric Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
,
Jurek Schultz
1   Department of Pediatric Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
,
Adrian Dragu
2   Department of Plastic Surgery, OUPC, University Hospital Carl Gustav Carus, Dresden, Germany
,
Guido Fitze
1   Department of Pediatric Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
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Abstract

A 7-year-old boy presented 6 weeks after open reduction and crossed Kirschner wire (K-wire) fixation of a supracondylar humerus fracture. Previous treatments had restored skeletal anatomy without documented complications. However, the patient would not move the entire arm, including his forearm and hand. Any passive movement led to anxious adverse reactions, and there was partial numbness of all fingers. After intensive physio- and occupational therapy supported by nerve stimulation and psychological counseling, anxiety-related functional deficits of the shoulder and elbow resolved to reveal the severe Volkmann contracture of the right hand developed fully. Electroneurography, X-ray, magnetic resonance imaging of the forearm, and ultrasonography showed nonfunctional ulnar and a partially disturbed radial motor nerve distal to the elbow along with damaged flexor muscles of the forearm after compartment syndrome. In addition, damage to the median nerve at the elbow level was diagnosed. After intense conservative therapy, we partially resected fibrotic fascia of the superficial flexor compartment, freed ulnar and median nerves, and performed staircase-like releases of tendons and tenotomies. We achieved a full range of motion of all fingers and markedly improved the range of motion of the wrist. The Disabilities of the Arm, Shoulder and Hand scores for function improved from 80 to 16 at the 2-year follow-up postoperatively, but some impairments of fine motor function persisted. Subtle symptoms of a developing compartment syndrome need to be recognized. Overlooked and untreated, a consecutive Volkmann contracture can turn the extremity nonfunctional. Intensive physical, psychological, and surgical therapy in a specialized center can restore function but requires endurance and perseverance throughout the lengthy recovery.

Keywords

Volkmann ischemic contracture - compartment syndrome - tenotomy - supracondylar fracture - children

Informed Consent

The patient and his mother gave written informed consent for the anonymous usage of their data and pictures.




Publication History

Received: 08 April 2021

Accepted: 02 March 2022

Article published online:
19 July 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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