Die nichtoperative Behandlung der isch�mischen Muskelkontraktur an Unterarm und Hand

Abstract

The acute compartment syndrome of the forearm and hand leads to severe muscle necrosis and nerve damage if the diagnosis is not recognized. The resulting ischemic contractures and paralyses require a distinctive regime of therapy. Therefore,physiotherapy and occupational therapy are of main importance. In mild cases exclusively nonoperative treatment is possible. The goal is to exercise the function of the remaining muscles, mobilize the joints, and stretch muscle scars. Severe forms need surgery. To reach the best starting point for the operation, extensive preoperative active and passive exercises as well as splint therapy are required. Postoperatively, this regime has to be continued to retain a favorable outcome. The treatment approach is demonstrated with a case report.

The Volkmann Ischemic Contracture of the Forearm is Preventable

“…Passive stretching of the fingers and wrist worsens pain, since it raises intra-compartmental pressure. Elevation of the arm decreases tissue perfusion and aggravates pain as well [3,8,11]. Pain progresses in time and hypoesthesia can extend to the entire hand.…”

“…Elevation of the arm should be avoided. It decreases perfusion pressure even more in contrast to tissue swelling from a simple edema or hematoma, where elevation relieves complaints [3,8,11]. Soon after the onset of symptoms an adequate fasciotomy using a curvilinear incision over the ventral aspect of the forearm and wrist should be performed (Figure 3).…”

“…Nonoperative treatment mainly consists of prolonged physiotherapy, which aims to improve joint motion and muscle force [9,11,22]. Mild contractures can be treated by physiotherapy alone, but in moderate and severe types it is only supplementary to surgery.…”

Distal Ulna Giant Cell Tumor Resection with Reconstruction Using Distal Ulna Prosthesis and Brachioradialis Wrap Soft Tissue Stabilization

“…The mortality of lung metastasis from giant cell tumor ranges from 14% to 23% in studies with follow-up longer than 8 years [2,14]. These thoughts have prompted surgeons to be more aggressive in treating distal ulna giant cell tumors with en bloc resection [12,16]. The functional reconstruction of the defect after resection has been a challenge [11,12,16].…”

“…These thoughts have prompted surgeons to be more aggressive in treating distal ulna giant cell tumors with en bloc resection [12,16]. The functional reconstruction of the defect after resection has been a challenge [11,12,16].…”