Volkmann's ischemic contracture

Volkmann's Ischemic Contracture
Synonyms	Ischemic contracture
Pronounce	N/A
Specialty	N/A
Symptoms	Pain, muscle weakness, contracture of the forearm
Complications	Permanent disability
Onset	Acute
Duration	Chronic
Types	N/A
Causes	Compartment syndrome, trauma, fracture
Risks	Fracture, crush injury, tight bandaging
Diagnosis	Clinical evaluation, imaging
Differential diagnosis	N/A
Prevention	N/A
Treatment	Surgical intervention, physical therapy
Medication	N/A
Prognosis	Variable
Frequency	Rare
Deaths	N/A

Volkmann's ischemic contracture is a medical condition that results from ischemia or lack of blood flow to the forearm muscles, leading to muscle and nerve damage. This condition is named after the German surgeon Richard von Volkmann, who first described it in the 19th century.

Pathophysiology

Volkmann's ischemic contracture is primarily caused by compartment syndrome, a condition where increased pressure within a closed muscle compartment compromises circulation and function of the tissues within that space. The forearm is particularly susceptible due to its anatomical structure, with rigid fascial boundaries that limit expansion.

When blood flow is restricted, muscle and nerve tissues can become ischemic and necrotic. This leads to fibrosis and shortening of the muscles, resulting in a contracture. The flexor muscles of the forearm are most commonly affected, leading to a characteristic flexion deformity of the wrist and fingers.

Causes

The most common causes of Volkmann's ischemic contracture include:

• Fractures of the humerus or radius and ulna, particularly supracondylar fractures in children.
• Crush injuries to the forearm.
• Tight bandaging or casts that increase compartment pressure.
• Burns or other injuries that cause significant swelling.

Clinical Presentation

Patients with Volkmann's ischemic contracture typically present with:

• Severe pain in the affected forearm, often out of proportion to the injury.
• Swelling and tightness in the forearm.
• Weakness or paralysis of the hand and wrist.
• A claw-like deformity of the hand due to flexion contractures.

Diagnosis

Diagnosis is primarily clinical, based on history and physical examination. Key diagnostic features include:

• Pain on passive stretching of the muscles in the forearm.
• Palpable firmness of the forearm compartments.
• Loss of sensation or motor function in the hand.

Imaging studies such as X-rays or MRI may be used to assess underlying fractures or soft tissue damage.

Treatment

Early recognition and treatment of compartment syndrome are crucial to prevent Volkmann's ischemic contracture. Treatment options include:

• Surgical intervention: Fasciotomy is performed to relieve pressure within the compartment. In established contractures, tendon lengthening or muscle release surgeries may be necessary.
• Physical therapy: Post-surgical rehabilitation is essential to restore function and prevent further contracture.
• Splinting: Dynamic splints may be used to maintain joint position and prevent worsening of the contracture.

Prognosis

The prognosis for Volkmann's ischemic contracture varies depending on the severity and duration of ischemia before treatment. Early intervention can lead to good functional recovery, while delayed treatment may result in permanent disability.

Prevention

Preventive measures focus on early detection and management of compartment syndrome. This includes:

• Careful monitoring of patients with forearm injuries for signs of increased compartment pressure.
• Avoiding overly tight bandages or casts.
• Prompt surgical intervention when compartment syndrome is suspected.

See Also

• Compartment syndrome
• Orthopedic surgery
• Ischemia