VOLKMANN'S CONTRACTURE AS A COMPLICATION OF SUPRACONDYLAR FRACTURE OF HUMERUS IN CHILDREN

Zoran Mito Bozinovski, Marija Jakimova, Daniela Georgieva, Roza Dzoleva-Tolevska, Jasmina Nanceva

Abstract


The patient TK, 7 years old, had sustained a supracondylar fracture of  the left elbow after fall on the left hand with elbow extended. She was admitted in local hospital where the clinical examination and X ray were made and they confirmed the diagnosis of supracondylar fracture of the left elbow (Gartland Type III). She was treated with closed reduction (without anaesthesia) and cast immobilization for four weeks. With poor to no function of the left hand she was send to physical therapy for duration of 10 days, but she did not gain her function of the left hand, almost all active movements of the left hand were impossible and the muscles of the left under arm were hypothonic. Due to loss of left hand function,EMG was made and the EMG result showed acute lesion of the nerves of the left forearm caused by possible nerve compression (n.ulnaris, n.medianus, n. radialis). After four months she was admitted in our Clinic were we perform operation of the left elbow with removing callus formation in which we find entrapped median and ulnar nerves. We also did an osteotomy of the humerus for correction of the angular deformity and fixation with K wire. The patient was put in cast immobilisation after surgery for four weeks. After the removal of the cast and K wire she was sent to intensive rehabilitation. One year after surgery she regain almost all of hand and elbow function with satisfying range of motion. She is now able to fullfil every day function without any help or support.

Full Text:

PDF

References


REFERENCES:

Wilkins KE. Fractures and dislocations of the elbow region. In: Rockwood CA Jr, Wilkins KE, King RE, editors. Fractures in children. 3rd ed. Philadelphia: JB Lippincott; 1991. pp. 526–617.

Henrikson B. Supracondylar fracture of the humerus in children. A late review of end-results with special reference to the cause of deformity, disability and complications. Acta Chir Scand Suppl. 1966;369:1–72.

Abraham E, Powers T, Witt P, Ray RD. Experimental hyperextension supracondylar fractures in monkeys. Clin Orthop Relat Res. 1982;(171):309–18

Ramachandran M, Birch R, Eastwood DM. Clinical outcome of nerve injuries associated with supracondylar fractures of the humerus in children: the experience of a specialist referral centre. J Bone Joint Surg Br. 2006;88(1):90–4. doi: 10.1302/0301-620X.88B1.16869.

Babal JC1, Mehlman CT, Klein G.Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis. J Pediatr Orthop. 2010 Apr-May;30(3):253-63

Campbell CC, Waters PM, Emans JB, Kasser JR, Millis MB. Neurovascular injury and displacement in type III supracondylar humerus fractures. J Pediatr Orthop. 1995;15(1):47–52. [

Ippolito E, Caterini R, Scola E. Supracondylar fractures of the humerus in children. Analysis at maturity of fifty-three patients treated conservatively. J Bone Joint Surg Am. 1986;68(3):333–44.

McGraw JJ, Akbarnia BA, Hanel DP, Keppler L, Burdge RE. Neurological complications resulting from supracondylar fractures of the humerus in children. J Pediatr Orthop. 1986;6(6):647–50.

Skaggs D, Pershad J. Pediatric elbow trauma. Pediatr Emerg Care. 1997;13(6):425–34.

Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet. 1959;109(2):145–54.

Camp J, Ishizue K, Gomez M, Gelberman R, Akeson W. Alteration of Baumann’s angle by humeral position: implications for treatment of supracondylar humerus fractures. J Pediatr Orthop. 1993;13(4):521–5.

Voss FR, Kasser JR, Trepman E, Simmons E, Jr, Hall JE. Uniplanar supracondylar humeral osteotomy with preset Kirschner wires for posttraumatic cubitus varus. J Pediatr Orthop. 1994;14(4):471–8.

Pirone AM, Graham HK, Krajbich JI. Management of displaced extension-type supracondylar fractures of the humerus in children. J Bone Joint Surg Am. 1988;70(5):641–50.

Boeck H, Smet P, Penders W, Rydt D. Supracondylar elbow fractures with impaction of the medial condyle in children. J Pediatr Orthop. 1995;15(4):444–8.

Leet AI, Frisancho J, Ebramzadeh E. Delayed treatment of type 3 supracondylar humerus fractures in children. J Pediatr Orthop. 2002;22(2):203–7.

Carmichael KD, Joyner K. Quality of reduction versus timing of surgical intervention for pediatric supracondylar humerus fractures. Orthopedics. 2006;29(7):628–32.

Mehlman CT, Strub WM, Roy DR, Wall EJ, Crawford AH. The effect of surgical timing on the perioperative complications of treatment of supracondylar humeral fractures in children. J Bone Joint Surg Am. 2001;83-A(3):323–7.

Edmonds EW1, Roocroft JH, Mubarak SJ.Treatment of displaced pediatric supracondylar humerus fracture patterns requiring medial fixation: a reliable and safer cross-pinning technique. J Pediatr Orthop. 2012 Jun;32(4):346-51




DOI: http://dx.doi.org/10.24125/sanamed.v11i1.73

Refbacks

  • There are currently no refbacks.


Copyright (c) 2016 SANAMED

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.