Volkmann's contracture

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Volkmann's contracture is a medical condition that results from ischemia (lack of blood flow) to the forearm muscles. This condition leads to a permanent shortening of the muscles, causing a claw-like deformity of the hand, fingers, and wrist. It is named after the 19th-century German surgeon Richard von Volkmann.

Causes

Volkmann's contracture is typically caused by increased pressure within the compartments of the forearm, a condition known as compartment syndrome. This increased pressure can result from various factors, including:

• Fractures of the forearm bones, particularly the supracondylar fracture of the humerus.
• Tight bandages or casts.
• Severe burns.
• Crush injuries.
• Prolonged use of a tourniquet.

Pathophysiology

The pathophysiology of Volkmann's contracture involves the following steps:

1. **Ischemia**: Reduced blood flow to the forearm muscles due to increased compartment pressure. 2. **Muscle and Nerve Damage**: Prolonged ischemia leads to muscle and nerve damage. 3. **Fibrosis**: Damaged muscle tissue is replaced by fibrous tissue, leading to contracture. 4. **Deformity**: The fibrous tissue causes the muscles to shorten, resulting in a claw-like deformity.

Symptoms

The symptoms of Volkmann's contracture include:

• Pain in the forearm.
• Swelling and tightness in the affected area.
• Weakness and loss of function in the hand and fingers.
• A claw-like deformity of the hand, with the wrist flexed and the fingers extended.

Diagnosis

Diagnosis of Volkmann's contracture is based on clinical examination and patient history. Imaging studies such as X-rays and MRI may be used to assess the extent of muscle and nerve damage.

Treatment

Treatment of Volkmann's contracture aims to relieve pressure and restore function. Options include:

• **Surgical Intervention**: Fasciotomy to relieve compartment pressure.
• **Physical Therapy**: To improve muscle strength and flexibility.
• **Splinting**: To maintain the hand in a functional position.
• **Reconstructive Surgery**: In severe cases, tendon transfers or other reconstructive procedures may be necessary.

Prevention

Preventive measures include:

• Prompt treatment of forearm fractures and injuries.
• Careful monitoring of patients with casts or bandages.
• Avoiding prolonged use of tourniquets.

Prognosis

The prognosis for Volkmann's contracture depends on the severity and duration of ischemia. Early diagnosis and treatment can improve outcomes, but severe cases may result in permanent disability.

See Also

• Compartment syndrome
• Ischemia
• Fasciotomy
• Richard von Volkmann