title: Results of neurolysis in established upper limb Volkmann's ischemic contracture.
abstract: BACKGROUND
  Treatment of established cases of Volkmann's ischemic contracture (VIC) of upper limb is very tedious. Since the period of Volkmann, various experimental works are being performed for its treatment, but none are effective. Disabilities from nerve palsy and hand muscle paralysis are more problematic than any other deformity in VIC. To solve these problems, we conducted a study to see the result of neurolysis of median and ulnar nerve and their subcutaneous placement in established cases of VIC.
  
  
  METHODS
  Twelve cases of established VIC operated between July 2007 and August 2010 with complete records and followup were included in the study. VIC of lower limb and contracture of nonischemic etiology were excluded from the study. Their evaluation was done by the British Medical Research Council grading system for sensory and motor recovery. Followup was done for an average period of 24.3 months (range 15-30 months) (the average age was 8.3 years).
  
  
  RESULTS
  To study the results, we divided the cases into two series. One group consisted of cases which were operated within 6 months from onset of VIC. The second group consisted of cases which were operated after 6 months from onset of VIC. Our results revealed that there was no statistically significant difference between the two groups operated, though both had significant improvement in motor and sensory recovery in both median and ulnar nerve distribution.
  
  
  CONCLUSIONS
  Neurolysis of the nerves definitely improved the outcome for motor and sensory components of median and ulnar nerves but the timing of the surgery did not play a role in the outcome contrary to the clinical assumption. This study can serve as a template and further such studies could help us find the answer to a long standing issue.
authors.affiliation: Department of Orthopaedics, Government Medical College, Kota, Rajasthan, India.
authors.forename: Dinesh K
authors.initials: DK
authors.lastname: Meena
authors.affiliation: Department of Orthopaedics, Government Medical College, Kota, Rajasthan, India.
authors.forename: Srikiran
authors.initials: S
authors.lastname: Thalanki
authors.affiliation: Department of Orthopaedics, Sawai Man Singh Hospital, Jaipur, Rajasthan, India.
authors.forename: Poornima
authors.initials: P
authors.lastname: Patni
authors.affiliation: Department of Orthopaedics, Government Medical College, Kota, Rajasthan, India.
authors.forename: Ram Khiladi
authors.initials: RK
authors.lastname: Meena
authors.affiliation: Department of Orthopaedics, Government Medical College, Kota, Rajasthan, India.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Bairawa
authors.affiliation: Department of Orthopaedics, Government Medical College, Kota, Rajasthan, India.
authors.forename: Chirag
authors.initials: C
authors.lastname: Bhatia
keywords: Median nerve; compartment syndromes; forearm; motor; neurolysis; retinaculum; sensory; ulnar nerve