No abstract available.
Ischemic Contracture*

In children, the supracondylar fractures of the humerus are common in elbow region, and often associated with various complications and problems in treatment (ie,Volkmann's ischemic contracture, cubitus valgus or varus deformity, rotational deformity). The results of reduction can be measured by Baumann's angle, carrying angle, trochlea-capitellum angle, and displacement of distal radial styloid process on radiological study. So we have made experiments on the process which various three dimensional displacements reflected into two dimensional Baumann's angle and humerocapitellar angle. And we investigated the process of rotation, through various radiological studies by means of molded models of humerus. The results were as follows:l. In experiments, AP & lateral X-ray studies showed no change in rotation of proximal segment of fracture with fixed distal segment of fracture. 2. On the other hand, AP & lateral X-ray showed significant change, in rotation of proximal fracture segment with distal segment of fracture. 3. Supracondylar rotation angle(S.R.A.)depicted as the ratio of the length of proximal fracture width minus that of the distal fracture width in lateral view, to the length of distal fracture width in AP view minus that of the distal fracture width in lateral view. 4. According to the modified Mitchell result, S.R.A. to the result of treatment was average 7.6 degree in excellent group, 15.2 degree in good group and 29.3 degree in unsatisfactory group.
Child ; Congenital Abnormalities ; Elbow ; Fungi ; Hand ; Humans ; Humerus ; Ischemic Contracture

1. Fifty one cases of fractures of the shaft of the femur in children, treated at Seoul National University Hospital during the seven years, from August 1962 to July 1969, were analyzed. 2. In thirty eight of the cases fracture involved the middle third of the shaft, in eleven the upper third, and in two the lower third. 3. Bryant traction was employed in fifteen of the cases ranging from four months to six years of age. One case, five years old, was complicated by Volkmanns ischemic contracture on both legs. 4. Russell traction was employed in eleven of the cases ranging from six to fourteen years of age. Angulation and distraction must be watched especially in the younger age group, although we encountered no serious complications which required subsequent treatment. 5. Hoke traction was employed in twelve of the cases ranging from six to eleven years of age. Although this form of treatment is not particularly popular, we are of the opinion that it is the treatment of choice over two years of age and,under six years of age and that between six and twelve years of age it may be optionally employed along with Russell traction. We found it. particularly useful and convenient in selected cases in which Russell traction could not be effectively employed. 6. In some of the complicated cases, open reduction and internal fixation, closed reduction with pin and plaster immobilization, or skeletal traction was employed.
Child ; Femur ; Humans ; Immobilization ; Ischemic Contracture ; Leg ; Seoul ; Traction

OBJECTIVE: To summarize the clinical characteristics, differential diagnosis, and treatment methods of finger flexion contracture caused by three kinds of forearm flexor diseases. METHODS: Between December 2008 and August 2021, 17 patients with finger flexion contracture were treated, including 8 males and 9 females, aged 5-42 years, with a median of 16 years. The disease duration ranged from 1.5 months to 30 years, with a median of 13 years. The etiology included 6 cases of Volkmann's contracture, all of which were flexion deformity of the 2nd to 5th fingers, accompanied by limitation of thumb dorsiflexion in 3 cases and limitation of wrist dorsiflexion in 3 cases; 3 cases of pseudo-Volkmann's contracture, including 2 cases of flexion deformity of middle, ring, and little fingers, and 1 case of flexion deformity of ring and little fingers; 8 cases of ulnar finger flexion contracture caused by forearm flexor disease or anatomical variations, all of which were flexion deformity of middle, ring, and little fingers. Operations such as slide of flexor and pronator teres origin, excision of abnormal fibrous cord and bony prominence, and release of entrapped muscle (tendon) were performed. Hand function was evaluated according to WANG Haihua's hand function rating standard or modified Buck-Gramcko classification standard, and muscle strength was evaluated according to British Medical Research Council (MRC) muscle strength rating standard. RESULTS: All patients were followed up 1-10 years (median, 1.5 years). At last follow-up, 8 patients with contracture caused by forearm flexor disease or anatomical variations and 3 patients with pseudo-Volkmann's contracture achieved excellent hand function, with muscle strength of grade M5 in 6 cases and grade M4 in 5 cases. One patient with mild Volkmann's contracture and 3 patients with moderate Volkmann's contracture without severe nerve damage had excellent hand function in 2 cases and good in 2 cases, with muscle strength of grade M5 in 1 case and grade M4 in 3 cases. Two patients with moderate or severe Volkmann's contracture had poor hand function, with 1 case of muscle strength of grade M3 and 1 case of grade M2, which improved when compared with those before operation. The overall excellent and good rate of hand function and the proportion of patients with muscle strength of grade M4 and above were 88.2% (15/17), respectively. CONCLUSION The finger flexion contracture caused by different etiology can be differentiated by analyzing the history, physical examination, radiographs, and intraoperative findings. After different surgical treatments, such as resection of contracture band, release of compressed muscle (tendon), and downward movement of flexor origin, most patients have a good outcome.
Male ; Female ; Humans ; Forearm/surgery* ; Contracture/surgery* ; Ischemic Contracture/surgery* ; Fingers/surgery* ; Muscle, Skeletal/surgery*

BACKGROUND: Ischemic preconditioning reduces the infarct size and the severity of arrhythmia in a post-ischemic reperfused heart although the detailed mechanism is unknown. In the ischemic heart, a large amount of catecholamine is released from the adrenergic nerve terminal and this aggravates cell destruction and arrhythmia. In this study, the possibility for ischemic preconditioning to inhibit the release of endogenous catecholamine from the ischemic heart was tested to investigate the probable cardioprotective mechanism of ischemic preconditioning. METHODS: In the isolated, Langendorff perfused rat hearts, we observed the protective effect of ischemic preconditioning against post-ischemic reperfusion injury, and measured the amount of catecholamine released into coronary effuent. In addition, we observed the effect of catecholamine depletion on reperfusion injury in non-preconditioned and preconditioned hearts. RESULTS: During the reperfusion(20min) after ischemia(30min), the cardiac function was markedly depressed with the development of severe contracture. In the heart preconditioned by three sequential episodes of 5min ischemia and 5min reperfusion, the reperfusion contracture decreased significantly and the cardiac function was almost recovered to normal after 20min reperfusion. The release of lactate dehydrogenase was also decreased in the preconditioned heart. The release of endogenous catecholamine was abruptly increased immediately after the reperfusion and the release was exponentially decreased throughout the reperfusion period. THe pattern of catecholamine release was much different from that of lactate dehydrogenase release. In the preconditioned heart, the release was significantly decreased to about half of that in non-preconditioned t\heart. Endogenous catecholamine depletion by reserpine treatment did not affect the post-ischemic functional recovery in both non-preconditioned and preconditioned hearts. CONCLUSION: It is suggested from these results that ischemic preconditioning inhibis the release of endogenous catecholamine during ischemic period, which may be partly related to cardioporotective effect of preconditioning in ischemic and reperfused heart.
Animals ; Arrhythmias, Cardiac ; Contracture ; Heart* ; Ischemia ; Ischemic Preconditioning* ; L-Lactate Dehydrogenase ; Rats* ; Reperfusion ; Reperfusion Injury ; Reserpine

1. Fifty one cases of fractures of the shaft of the femur in children, treated at Seoul National University Hospital during the seven years, from August 1962 to July 1969, were analyzed. 2. In thirty eight of the cases fracture involved the middle third of the shaft, in eleven the upper third, and in two the lower third. 3. Bryant traction was employed in fifteen of the cases ranging from four months to six years of age. One case, five years old, was complicated by Volkmanns ischemic contracture on both legs. 4. Russell traction was employed in eleven of the cases ranging from six to fourteen years of age. Angulation and distraction must be watched especially in the younger age group, although we encountered no serious complications which required subsequent treatment. 5. Hoke traction was employed in twelve of the cases ranging from six to eleven years of age. Although this form of treatment is not particularly popular, we are of the opinion that it is the treatment of choice over two years of age and,under six years of age and that between six and twelve years of age it may be optionally employed along with Russell traction. We found it. particularly useful and convenient in selected cases in which Russell traction could not be effectively employed. 6. In some of the complicated cases, open reduction and internal fixation, closed reduction with pin and plaster immobilization, or skeletal traction was employed.
Child ; Clinical Study ; Femur ; Humans ; Immobilization ; Ischemic Contracture ; Leg ; Pelvis ; Seoul ; Traction

Supracondylar fracture is the most frequent injury of the elbow and frequently accompanies complications in children. Seventy two cases of supracondylar fractures have been treated and managed at Department of Orthopaedic Surgery, Catholic Medical College during the period from Jan. 1969 to Dec. 1972. The evaluation of fracture was done according to the classification of Holmberg and Hoyer. Among 72 cases of the supracondylar fracture, the most common type is 29 cases of Grade 2: (40.2%). Most cases were treated conservatively, and various method of treatment were adopted according to the condition of fracture. Residual angular deformities after successful manipulative reductiion can be accurately evaluated roentgenographically by the Baumanns method. Good results were obtained in 62.6%, fair results in 33.3%, and poor results in 4.1%. The incidence of cubitus varus deformity is 37.5%. There were no instance of ischemic contracture and no permanent neurological deficit in fracture cases.
Child ; Classification ; Congenital Abnormalities ; Elbow ; Humans ; Humerus ; Incidence ; Ischemic Contracture ; Methods

Application of the Gracilis or Pectoralis Musculocutaneous Free Flap to restore finger fiexion after destruction of forearm flexors had been reported by a surgical team at the Six Peoples Hospital at Shanghi in 1976. Viability is maintained by microvascular anastomoses of the muscles artery and vein to a suitable artery and vein in the recipient site. Gracilis is suitable for obtaining the dynamic requirement of transplanted forarm flexors. We presented two cases of muscle transplantation using Gracilis Musculocutaneous Free Flap for the loss of function of the long flexors to digits due to Volkmanns ischemic contracture of which one was after supracondylar fracture and the other was infection after deep laceration on elbow. In both cases transplanted muscles survived but funtioning was well in one case and other case was not good due to the previous infection. In first case, excellent grip strength and nearly a full flexor finger movement was provided by transplanted muscles.
Arteries ; Elbow ; Fingers ; Forearm ; Free Tissue Flaps ; Hand Strength ; Ischemic Contracture ; Lacerations ; Microsurgery ; Muscles ; Transplantation ; Veins

OBJECTIVE: Pralidoxime is widely used for the treatment of organophosphate poisoning. Multiple studies have reported its vasoconstrictive property, which may facilitate the restoration of spontaneous circulation (ROSC) after cardiac arrest by increasing the coronary perfusion pressure (CPP). 2,3-Butanedione monoxime, which belongs to the same oxime family, has been shown to facilitate ROSC by reducing left ventricular ischemic contracture. Because pralidoxime and 2,3-butanedione monoxime have several common mechanisms of action, both drugs may have similar effects on ischemic contracture. Thus, we investigated the effects of pralidoxime administration during cardiopulmonary resuscitation in a pig model with a focus on ischemic contracture and CPP.METHODS: After 14 minutes of untreated ventricular fibrillation, followed by 8 minutes of basic life support, 16 pigs randomly received either 80 mg/kg of pralidoxime (pralidoxime group) or an equivalent volume of saline (control group) during advanced cardiovascular life support (ACLS).RESULTS: Mixed-model analyses of left ventricular wall thickness and chamber area during ACLS revealed no significant group effects or group-time interactions, whereas a mixed-model analysis of the CPP during ACLS revealed a significant group effect (P=0.038) and group-time interaction (P<0.001). Post-hoc analyses revealed significant increases in CPP in the pralidoxime group, starting at 5 minutes after pralidoxime administration. No animal, except one in the pralidoxime group, achieved ROSC; thus, the rate of ROSC did not differ between the two groups.CONCLUSION: In a pig model of cardiac arrest, pralidoxime administered during cardiopulmonary resuscitation did not reduce ischemic contracture; however, it significantly improved CPP.
Animals ; Cardiopulmonary Resuscitation ; Diacetyl ; Heart Arrest ; Hemodynamics ; Humans ; Ischemic Contracture ; Organophosphate Poisoning ; Perfusion ; Swine ; Ventricular Fibrillation

Percutaneous transluminal angioplasty is being used to treat peripheral artery disease increasingly in place of conventional peripheral vascular surgery. Critical limb ischemia is the most severe form of peripheral artery disease and presents with ischemic resting pain and non-healing foot wounds or gangrene. It can result in amputation and increased mortality if aggressive revascularization to obtain sufficient blood is not performed as soon as possible. Generally, both femoral arteries are used for vascular access. However, we could not use the femoral artery for vascular access in a patient with multiple contractures of the extremities due to an old cerebral infarction. Consequently, we used the left brachial artery to perform successful revascularization of the left foot in critical limb ischemia.
Amputation ; Angioplasty* ; Brachial Artery ; Cerebral Infarction* ; Contracture* ; Extremities* ; Femoral Artery ; Foot ; Gangrene ; Humans ; Ischemia* ; Ischemic Contracture ; Limb Salvage* ; Mortality ; Peripheral Arterial Disease ; Wounds and Injuries