Total wrist fusion for Volkmann’s ischaemic contracture (Using Synthes fusion plate)
Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.
Learn the Total wrist fusion for Volkmann’s ischaemic contracture (Using Synthes fusion plate) surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Total wrist fusion for Volkmann’s ischaemic contracture (Using Synthes fusion plate) surgical procedure.
Volkmann’s ischemic contracture is a complication of compartment syndrome of the forearm. Untreated compartment syndrome results in degeneration of the forearm muscles and nerves resulting in contractures.
It is classified by Holden into Type I and II. In Type the pathology is proximal to the forearm such as a vascular occlusion or injury.
Type I can be mild, moderate or severe.
In the mild type, there is involvement of the deep muscle compartment mainly FDPs to middle and ring fingers. There may be partial involvement of FPL and pronator teres muscles and median nerve.
The moderate type is called the classic type. In this there is involvement of the FDPs, FPL and pronator teres. Median nerve is involved and there may be partial involvement of the ulnar nerve. The hand is in an ‘intrinsic minus’ posture.
In the severe type all flexors and pronators are involved with partial or total involvement of the extensors and instrinsics. Median and ulnar nerves are involved. The hand is in an intrinsic minus posture. Median and ulnar nerves are involved. Soft tissue coverage may be tight.
In Type II the muscle injury is limited to the site of direct trauma. The extent of muscle injury is usually limited to the forearm compartment. There may be damage to the nerves and loss of soft tissue. The extent of the finger deformity is related to the degree of muscle injury.
Corrective surgery for Volkmann’s ischaemic contracture is dependent on the type of contracture and degree of involvement of various muscle compartments. The case discussed here is a Holden Type I severe type from a vascular occlusion in the upper arm. He presented with an acute compartment syndrome which was released but unfortunately it was delayed and there was already muscle necrosis.
He presented with a fixed flexion deformity of the wrist, hypertension at MCP joints of the fingers and flexion at interphalangeal joints. An MCP joint release using dorsal capsulotomy was done initially and a flexor muscle slide was attempted later. Unfortunately both these operations were unsuccessful.
This operation is aimed at correcting the wrist deformity through a total wrist fusion and a later tendon transfer to move the ECRL to FDPs of the fingers. He may also need a fusion of the thumb CMC joint in an anatomical position and a transfer of EIP to FPL.
The steps of a total wrist fusion is explained through this operation.
When performing a total wrist fusion, the radio-carpal joint, capito-lunate joint and third CMC joint are fused. In this case the joints between capitate and hamate and between triquetrum and hamate are also included in the fusion to increase the strength. The distal radio-ulnar joint is left intact which usefully preserves pronation & supination.
Author: Mr Rajive Jose FRCS
Institution : The Queen Elizabeth Hospital ,Birmingham ,UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.