Volkmann's contracture / by Leonard S. Dudgeon.

  • Dudgeon, Leonard S., 1876-1938.
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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    in the hand was good and the skin was quite normal. The patient worked now as a watchman and could do his work, or any other, per- fectly well. Case 3.—A child, aged five years, was admitted to St. Thomas’s Hospital on June 25th, 1898, under the care of Mr. Pitts. On April 20th, 1898, he had fallen down and fractured his right arm. When seen in the casualty department of the above hospital it was found that there was a greenstick fracture of the right ulna and radius at the junction of the middle and upper thirds. This was set and put up on anterior and posterior splints. He was seen again in a week (April 27th), when the splints were removed and the arm appeared to be progressing satisfactorily; the splints were re-applied, and the patient was seen again on May 3rd, when the arm was in good condition and the splints were again re-applied until May 9th. During this last week the boy’s mot her noticed the fingers to be slightly swollen. On removal of the splints a sore was found on the flexor surface of the forearm; this was dressed and the splints were re-applied. On May 25tli the wound was almost healed, but the fingers were flexed and the wrist was slightly contracted. Passive movements, massage, and the galvanic battery were given every other day. but the con- tracture did not improve. On admission into the hospital he seemed to be a healthv-looking boy with contraction of the hand. The wrist was partially flexed, and the fingers—i.e., the two terminal phalanges—were strongly flexed and could only be extended on full flexion of the wrist. The wrist and fingers could not be extended at one and the same time. There was no loss of power of extension of the wrist. The electrical re- actions were normal. The treatment adopted was massage twice daily. On August 15th there was considerable improvement in the affected arm; the tendons were not so tense and the wrist-joint was moved with more freedom. The patient left the hospital on August 6th, 1898. At my request the child came to see me in the electrical department on Nov. 14th, 1901. Over three years had elapsed since the accident. There was now absolutely no deformity of the hand and the position of the fingers was normal. There were very slight weakness and wasting of the forearm muscles, which were firm and hard. The scar of the old pressure sore was a prominent landmark about the middle of the forearm. Sensation was normal and the electrical reactions were also normal. The mother, to whom the recovery was chiefly due, told me that she had per- sistently, and right up to the time of my seeing the patient, carefully rubbed his arm night and morning. He had also been taught to manipulate the mangle and, as soon as he could do so, to wring out washing; in fact, every movement that was of any service was employed. The boy was taught to bend his fingers backwards when- ever he could, and it was done for him every night and morning after the massage. The deformity very gradually disappeared—in fact, it was only during the last three months—i.e., since August, 1901—that there had been noticed complete absenco of any deformity. The patient was now able to do ordinary work as well as any one of his own age. Case 4.—The patient, a child, aged four years, was an out-patient at, St. Thomas’s Hospital. On Dec. 6th, 1900, she had broken her right upper arm just above the elbow. There was a good deal of swelling at the time. She came to the casualty department, where the arm was put up in a flexed position in plaster splints. On the next day the fingers were swollen and were, according to the child’s mother, dark in colour, but this fact was absolutely disregarded by the parents.