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Modified Colzi method in the management of established Volkmann contracture--the experience of Trzebnica Limb Replantation Center (preliminary report).

BACKGROUND
"The terrible disability of irreversible ischaemic flexion contracture of the metacarpi and digits known as Volkmann's contracture can be avoided in the vast majority of cases, but never completely cured" (M. Koszla). A modification of Colzi's forgotten technique for the treatment of Volkmann's contracture is presented together with our treatment outcomes.


MATERIAL AND METHOD
The Colzi procedure was performed in 15 patients aged: 3-54 years with Buck-Gramcko grade III, III/IV and IV Volkmann's contractures. Time between injury and surgery ranged from 4.5 months to 21 years. The main manoeuvre to reduce the contracture was two-level shortening osteotomy in the proximal and distal thirds of the radius and ulna. Osteosynthesis was performed by Rush intramedullary nailing.


RESULTS AND CONCLUSIONS
A very good range of mobility (from 17 degrees preop. to 56 degrees postop.), force (0.73 preop.- 7.6 kg postop.) and contracture correction (183 degrees preop. - 27 degrees postop.) was achieved. Complications in the form of delayed union or secondary fractures occurred in 4/15 patients, and were managed by prolonged immobilisation and decortication with bone grafting. The modified Colzi procedure proved its value as a universal, easy, minimally invasive and safe method of treatment of Volkmann's contracture regardless of patient age, duration of illness, previous therapy, and stage of contracture.