[Neurovascular transfer of the m. gracilis for the treatment of Volkmann's contracture following supracondylar fracture in childhood].
Children are particularly prone to developing moderate to severe Volkmann's ischemic contracture following a supracondylar fracture of the humerus or its treatment. In order to treat such contractures, intensive hand therapy and a gracilis free muscle transfer to the digital flexors were used in 8 patients at an average age of 6 years 2 months. All transfers were successful. At follow-up (1 to 8 years, average 3 years), despite limited wrist extension in 5/8 patients and mean grip and pinch strengths between 22 and 43% of normal for age and dominance, all patients regained considerable finger flexor excursion (tip to crease distances of 0 to 5.0 cms, average 1.68 cms). Although fine motor assessment using the M.A.N.D. battery of tests placed the patients in the moderate disability range, 7/8 patients became independent in the tested activities of daily living with the exception of buttoning a cuff with the involved hand, which was difficult for 5/8 subjects. Quantifiable measurements underestimated the renewed importance of the operated hand. Compensatory motion at the shoulder allowed positioning the hand which changed from being nearly useless to becoming a functionally non-dominant hand well integrated into daily life.
Egerszegi
E P
EP
Service de Chirurgie Plastique, Hôpital Sainte-Justine, Montréal, Québec, Canada.
Zuker
R M
RM
Caouette-Laberge
L
L
Manktelow
R T
RT
McLeod
A M
AM
Candlish
S E
SE
Garon
N
N
D002648:Child; D002675:Child, Preschool; D003161:Compartment Syndromes / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D006810:Humeral Fractures / Q000150:complications*; D008297:Male; D009132:Muscles / Q000637:transplantation*; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D013848:Thigh / Q000601:surgery
Transfert neurovascularisé du gracilis pour le traitement de la contracture de Volkmann suite à une fracture supracondylienne à l'âge pédiatrique.