textabstractLoss of hand function can be a frightening experience, the hand is an integral part of what makes us human. Nowhere else in the body is there such an amazing and complex functioning of bones, joints, muscles, tendons, nerves, blood vessels and skin as in the hand. The proper function and balance of all these elements is required for the hand to function to its full potential. The hands are the primary tool for interacting with our environment and, through touch, are also crucial for receiving information about our surroundings. About a quarter of the motor cortex in the human brain (the part of the brain which controls all movement in the body) is devoted to the muscles of the hands. This is usually illustrated with a drawing of a human figure draped over the side of the brain, body parts sized proportional to the amount of brain devoted to their movement, referred to as a homunculus - as illustrated in this drawing from Dr. Wilder Penfield’s monograph “The Cerebral Cortex of Man”. Until illness or injury forces people to focus on the importance of their hands, few people ever consider the consequences of being unable to use them. Any loss of hand function can have serious economic and psychological consequences. In fact, losing the use of your hand often means losing your job. Our hands are also part of our identity. Patients with severe upper extremity injuries can suffer psychologically from post-traumatic stress disorder. Unfortunately, we often fail to appreciate the function of the upper limb until it is injured, and that happens quite often.

The main objective of this retrospective study was to evaluate the long-term functional outcome in patients treated for Volkmann's ischemic contracture. In this study, functional outcome (measured as mobility, grip strength, and sensibility) and arm length difference after treatment of Volkmann's ischemic contracture were analyzed and discussed. Twenty-five patients treated between 1969 and 2001 were evaluated. The method of treatment was related to the severity of the infarction, ranging from conservative to free vascularized muscle transplantation. Although the study population was small, we could observe a wide range of functional outcome. Substantial improvement of function was obtained in patients who had free vascularized muscle transplantation. Unfortunately in one patient with an occlusion of the distal brachial artery and an insufficient flow through the collateral circulation of the radial artery, the gracilis muscle was lost. Tendon lengthening had unsatisfactory results because of recurrence of the contracture. Excision of fibrotic muscle tissue, neurolysis and tenolysis sometimes combined with a tendon transfer gave good hand function results in patients with sufficient remaining muscle tissue. In most of the patients in whom the contracture developed during childhood, a difference in forearm length was observed.

The success of an outcome study depends largely on the number of recruited patients, the loss of followup, and the response rate to postal questionnaires. In this article, different strategies were proposed to increase the aforementioned items. Most presented strategies were developed because of failure of measures used earlier. In the authors' study concerning hand surgery, this resulted in missed inclusions and loss of followup. It is hoped that by reading and using the strategies discussed, future researchers will start at the end of the learning curve and will shed a bright light on the obscurity of recovery after hand injury.

It may be concluded that treatment of patients with Volkmann's ischemic contracture is complicated and depends on a number of different variables. Optimal treatment of an established contracture requires a through examination of the extent of damage of the ischemia, followed by conservative therapy or operation. The most important measures concerning Volkmann's ischemic contracture, however, involve measures to prevent the contracture. It is poignant that very simple measures, such as monitoring high-risk injuries and immediate vascular repair or decompression if symptoms of a compartment syndrome are present, can prevent this disabling condition. The following summaries hopefully provide guidelines for prevention and treatment of Volkmann's ischemic contracture.