The flexor group of muscles in the anterior forearm may be divided into a superficial group and a deep group. Out of these two terminal branches, the ulnar artery is responsible for the blood supply of the flexor group of muscles. The brachial artery courses down the humerus, runs through the elbow, and then divides into the two terminal arteries, the radial and ulnar arteries. These muscles are supplied by the branches of the brachial artery. These muscles are responsible for movements at the wrist, metacarpophalangeal joints, and interphalangeal joints. The forearm extends from the elbow to the wrist and has two groups of muscles, the anterior flexor group and the posterior extensor group. The principal bone of the arm, the humerus, connects the ulna and radius (bones of the forearm) with the scapula. The upper limb can be divided into three sections: arm, forearm, and hand. This presentation is due to the permanent shortening of the flexor group of muscles in the forearm and thus may result in pain on passive flexion of the wrist and fingers. This condition is a permanent flexion deformity at the wrist and fingers that results in a claw-like presentation of the hand. Ischemic refers to the possible etiology, and contracture indicates shortening. The name Volkmann ischemic contracture is self-explanatory. In this series, both AIN and median nerve palsies among patients presenting with pulseless extremity and Gartland III or IV SCH fracture, offer similar rates of OR, risk of compartment syndrome, and resolution of nerve palsy.Volkmann contracture, also known as Volkmann ischemic contracture, is a claw-like deformity of the hand named after the 19-century German doctor Richard von Volkmann. In patients with at least 3-month neurological follow-up, 59 (of 61, 97%) patients had complete resolution of nerve palsy.Īlthough previous authors have suggested a pulseless SCH fx with an associated AIN or median nerve injury should be treated with exploration and OR, 70% (50/71) of the patients in this series were treated with a CR. Compartment syndrome developed in 6 (of 71, 8.5%) patients and was associated with poor perfusion status on presentation and delayed time from injury to surgery. 6.5%), and ultimate resolution of nerve palsy (4/36 20.1% vs. There was no significant difference between patients presenting with median nerve versus AIN palsy, with similar rates of need for OR (10/40 25% vs. Forty patients were diagnosed with median nerve palsy versus 31 diagnosed with AIN palsy. Of the 19 patients who underwent OR and early exploration, 6 needed vascular procedures, 5 required detethering of entrapped surrounding fibrous tissues. One patient developed compartment syndrome approximately 9 hours after CRPP (13.5 h after time of injury) and underwent emergent fasciotomies. The index procedure of CR plus percutaneous pinning was sufficient treatment in 50 (of 52, 96%) patients with only 2 requiring reoperation. Choice of treatment, details regarding preoperative and postoperative exam findings, follow-up course, and outcome were recorded.Ī total of 71 patients met inclusion criteria 52 patients (73%) underwent closed reduction (CR) 19 patients (27%) underwent open reduction (OR) and early antecubital fossa exploration. The purpose of this study was to determine the incidence of pulseless supracondylar humerus fractures associated with AIN or median nerve injury, to assess open versus closed surgical management, to determine factors associated with the need for neurovascular intervention, and to report the outcome.Ī retrospective review was performed at 4 pediatric trauma hospitals on all patients who sustained a Gartland III or IV supracondylar humerus fracture with the combination of absent distal palpable pulses and AIN or median nerve injury between 20. Optimal management for a pulseless supracondylar humerus fracture associated with anterior interosseous nerve (AIN) or median nerve injury is unclear.
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