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Volkmann's contracture in children: aetiology and prevention
Insights
Volkmann
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
Background:
- Volkmann's contracture is a severe complication following limb injuries in children.
- Established ischemia after Bryant's traction for femur fractures leads to poor outcomes.
- Supracondylar elbow fractures often involve arterial injury and compartment syndrome.
Purpose of the Study:
- To review the incidence and outcomes of Volkmann's contracture in children.
- To identify contributing factors and treatment delays in pediatric Volkmann's contracture cases.
Main Methods:
- Retrospective review of 55 children diagnosed with Volkmann's contracture between 1955 and 1975.
- Analysis of treatment methods, including Bryant's traction, Thomas' splint, and Bradford frame.
- Examination of associated injuries like femur fractures and supracondylar elbow fractures.
Main Results:
- Fifty-eight limbs were affected by Volkmann's contracture.
- Ten patients transferred with established ischemia post-Bryant's traction had poor outcomes.
- Most children did not receive timely, appropriate treatment for their condition.
Conclusions:
- The frequency of pediatric Volkmann's contracture has not decreased despite published warnings.
- Delayed treatment and specific fracture management (Bryant's traction, supracondylar elbow fractures) are critical factors.
- Improved awareness and timely intervention are crucial for better outcomes in pediatric limb injuries.
Abstract:
A review was conducted of the records of fifty-five children who were admitted to the Hospital for Sick Children in Toronto between 1955 and 1975 with a diagnosis of Volkmann's contracture in fifty-eight limbs. Ten patients had been transferred to this hospital with established ischaemia after Bryant's traction for a fractured femur; all had a very poor outcome. Thirteen other cases of Volkmann's contracture affecting the superficial posterior compartment had been treated with a fixed Thomas' splint and a Bradford frame after fractures of the femoral shaft. Supracondylar fractures of the elbow resulting in Volkmann's contracture frequently had both an arterial injury and a compartment syndrome. Most of the fifty-five children reviewed here had not had early appropriate treatment. For the past twenty-one years the frequency of Volkmann's contracture has not declined in spite of many published reports on the compartment syndrome, and the hazards of supracondylar fractures and of Bryant's traction.