Title : Reconstructing the ischaemic forearm: Synergistic role of Ilizarov Technique (IT) and soft tissue procedures in volkmann contracture
Abstract:
Volkmann Ischemic Contracture (VIC) is a disabling complication of acute compartment syndrome, typically following forearm trauma in pediatric and young adult populations. It results from prolonged ischemia of the deep flexor compartment, leading to muscle necrosis, fibrosis, and progressive contracture deformities of the wrist, fingers, and thumb. VIC is classified based on the Tsuge classification into mild, moderate, and severe types. Mild cases exhibit minor flexion deformities with preserved motor function; moderate cases involve moderate contractures and some motor impairment; severe VIC presents with extensive muscle necrosis, clawing, and functional paralysis.The primary objective in treating mild to moderate VIC is to restore functional alignment and muscle- tendon balance. This abstract presents a reconstructive approach that integrates targeted soft tissue release procedures with Ilizarov external fixation to achieve effective deformity correction and functional rehabilitation.
Soft tissue procedures include selective muscle slide techniques, such as the flexor-pronator origin slide, which facilitates lengthening of fibrotic muscle bellies, and fractional tendon lengthening or Z-plasty of the flexor digitorum profundus, flexor digitorum superficialis, and flexor pollicis longus. These methods reduce contractile tension, allowing gradual passive correction of the wrist and finger deformities without compromising residual motor power. In moderate cases with median or ulnar nerve involvement, neurolysis or tendon transfers may be adjunctively performed.
Following soft tissue balancing, a circular Ilizarov ring fixator was applied. Gradual distraction was initiated at a controlled rate of 0.25 mm four times per day (1 mm/day total), targeting correction of wrist flexion and finger clawing over several weeks. This method leverages the Ilizarov principles of distraction histogenesis, allowing adaptive remodeling of neurovascular and soft tissue structures. Importantly, the device permitted concurrent physiotherapy within the frame, facilitating early mobilization and promoting active engagement of residual motor units.
Rehabilitation included guided physical therapy, occupational therapy for hand function retraining, and staged removal of the fixator after radiologic and clinical confirmation of alignment correction. Functional outcomes were assessed using standardized tools such as the Disabilities of the Arm, Shoulder and Hand (DASH) score, muscle strength grading, and range of motion metrics.
In our observational cohort of patients with traumatic mild to moderate VIC, this combined approach yielded substantial improvements in deformity correction, hand prehension, and independence in daily activities. Complication rates were low, with no instances of neurovascular compromise or recurrence of contracture at 6 month follow-up.In conclusion, the integration of soft tissue release procedures with the Ilizarov technique offers a comprehensive, stepwise solution for managing mild to moderate Volkmann ischemic contracture. It effectively addresses both the static deformity and dynamic functional limitations of the forearm and hand. This multidisciplinary reconstructive strategy results in a well-aligned, functional limb and represents a promising approach in the surgical armamentarium for post-traumatic VIC.
