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Neonatal Volkmann's ischemic contracture of the forearm: a report of five cases
L Caouette-Laberge1, P Bortoluzzi, E P Egerszegi
1Department of Plastic Surgery, Université de Montréal Hôpital Sainte-Justine, P.Q., Canada.
Insights
Neonatal forearm wounds with nerve damage may indicate Volkmann's ischemic contracture. Recognizing this condition separately aids early diagnosis and treatment, improving outcomes for affected children.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Orthopedic Surgery
Background:
- Forearm wounds in neonates can present with motor and sensory deficits.
- The condition's evolution resembles Volkmann's ischemic contracture.
- Distinguishing this from other neonatal upper extremity conditions is crucial.
Observation:
- Five cases of neonates with forearm wounds and neuromuscular deficits are presented.
- The wounds evolved into muscle retraction, characteristic of ischemic contracture.
- Previous similar cases were misdiagnosed as upper extremity gangrene or aplasia cutis congenita.
Findings:
- Neonatal Volkmann's ischemic contracture of the forearm is proposed as a distinct clinical entity.
- Early diagnosis is vital, particularly when intracompartmental pressures are elevated.
- The study differentiates these cases from congenital anomalies and other neonatal conditions.
Implications:
- Establishing neonatal Volkmann's ischemic contracture as a separate diagnosis can improve patient management.
- Prompt diagnosis allows for timely intervention, including hand therapy and splinting.
- Minimizing late sequelae requires early recognition and appropriate treatment strategies.
Abstract:
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.