Volkmann's contracture / by Leonard S. Dudgeon.

  • Leonard Dudgeon
Date:
1902
Catalogue details

Licence: In copyright

Credit: Volkmann's contracture / by Leonard S. Dudgeon. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    IB them. Absence of hemorrhage and dryness of the wound were nearly as marked as in Case 11. The parts healed by first intention. The same treatment was adopted as was used in the last case. A chronic, painless whitlow appeared on the index finger. Improvement was very marked after four months’ treatment. As the hand was still pronated Mr. Barnard operated again on Oct. 20th. The pronator quadratus was separated from its ulnar attachment, then the forearm was readily supinated and fixed in this position on a splint. The after-treatment consisted of a splint at night, passive movements, and massage every day. There was very fair rotation of the forearm. In this case and in Case 11 the patients were progressing favourably at the time that this paper was written. The electrical reactions of the muscles of the forearm in this case were made by Dr. W. S. Hedley lately, who stated that he obtained a reaction of degeneration. Case 13.—The patient, a female, aged 20 years, came under the care of Mr. F. C. Wallis,1*) at Charing Cross Hospital in July, 1900, with the rare deformity of congenital absence of the superior radio-ulnar articula- tion in both forearms. The right forearm was capable of some degree of supination, but in the left it was impossible to obtain any such move- ment. In consequence the girl was unable to earn her living. Mr. Wallis operated at the earnest desire of the patient and her friends on July 6t,h, 1900. The operation took one and a quarter hours, and during this time an Esmarch’s bandage was kept round the upper arm. The radius was divided close to the head and the arm was forcibly supinated; in doing this the ulna was fractured in its lower third. The wound was closed and the arm was fixed in splints. 24 hours later the arm. which was much swollen, was red and covered in places with large bull®. Paralysis and loss of sensation seemed complete and the general temperature was raised. The splints were immediately removed and some stitches were taken out to relieve tension and the arm was redressed. There was no suppuration, gradually the swelling diminished, but the paralysis continued, and the fingers assumed the position of main-en-griffe. 10 days after the operation it was found that the anesthesia of the forearm and hand was confined chiefly to the ulnar and median distribution. Passive movements were now daily performed and galvanism was applied, but the ends of the fractured ulna were unable to unite owing to these movements. Three months after the operation Mr. Wallis wired the fractured bone with good result. The condition of the hand and fore- arm after the ulna had united was reported to be as follows: “With the wrist extended the second and third phalanges are flexed on the palm ; with the wrist flexed the fingers can be extended ; the thumb is practically useless and the muscles of the hand are much wasted. Loss of sensation as before.” For the next seven months the hand and forearm were daily galvanised and faradised, and a hot-air bath was used. Massage was daily performed and on three separate occasions the wrist and fingers were manipulated under gas. This treatment at first gave good results; the muscles of the upper part of the forearm improved, the fingers could be easily extended, and a certain amount of active movement was restored to the fingers and thumb. The wrist was more pliable and sensation was much improved. The skin was normal. This was the condition of the patient’s arm nearly 12 months after t he original operation. A second operation was now performed. The tendons of the flexor sublimis, the flexor profundus, and the flexor carpi radialis were divided and lengthened in the usual way. The tendon sheaths on being opened were found to be much thickened and more vascular than usual. The median nerve was found to be surrounded by fibrous tissue, which was adherent to the nerve sheath. The muscles exposed
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