Volkmann's contracture, also known as Volkmann's ischaemic contracture, is a permanent flexion

Flexion

In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular systems work together to move the joint into a "flexed" position. For example the elbow is flexed when the hand is brought closer to the shoulder...

 contracture

Contracture

A muscle contracture is a permanent shortening of a muscle or joint.. It is usually in response to prolonged hypertonic spasticity in a concentrated muscle area, such as is seen in the tightest muscles of people with conditions like spastic cerebral palsy....

 of the hand

Hand

A hand is a prehensile, multi-fingered extremity located at the end of an arm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs...

 at the wrist

Wrist

In human anatomy, the wrist is variously defined as 1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand;...

, resulting in a claw-like deformity of the hand and fingers. It is more common in children. Passive extension of fingers is restricted and painful. On examination the fingers are white or blue and cold and the radial pulse is absent.

History

It is named after Dr. Richard von Volkmann

Richard von Volkmann

Richard von Volkmann , was a prominent German surgeon and poet.He was born in Leipzig in 1830, the son of A.W. Volkmann. Richard entered medical school in Berlin and graduated in 1854...

 (1830 - 1889), the 19th century German doctor who first described it, in a paper on "non-Infective Ischemic conditions of various fascial compartments in the extremities". Because the contracture occurred at the same time as the paralysis, he considered a nerve etiology to be unlikely.

Causes

Any fracture in elbow region or upper arm may lead to Volkmann's ischemic contracture but commonly caused due to supracondylar fracture

Supracondylar fracture

A supracondylar fracture is a fracture, usually of the distal humerus just above the epicondyles, although it may occur elsewhere. While relatively rare in adults it is one of the most common fractures to occur in children and is often associated with the development of serious...

 of the humerus

Humerus

The humerus is a long bone in the arm or forelimb that runs from the shoulder to the elbow....

.

Volkmann's contracture results from acute ischaemia/necrosis

Necrosis

Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...

 of the muscle fibres of the flexor group of muscles of the forearm, specially flexor digitorum profundus and flexor pollicis longus

Flexor pollicis longus muscle

The flexor pollicis longus is a muscle in the forearm and hand that flexes the thumb...

 which becomes fibrotic and short.

It is caused by obstruction on the brachial artery

Brachial artery

The brachial artery is the major blood vessel of the arm.It is the continuation of the axillary artery beyond the lower margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa at the elbow. It then divides into the radial and ulnar arteries...

 near the elbow, possibly from improper use of a tourniquet

Tourniquet

An emergency tourniquet is a tightly tied band applied around a body part sometimes used in an attempt to stop severe traumatic bleeding. Tourniquets are also used during venipuncture and other medical procedures. Severe bleeding means the loss of more than 1,000 ml of blood. This flow of blood...

, improper use of a plaster cast

Orthopedic cast

An orthopedic cast, body cast or surgical cast, is a shell, frequently made from plaster, encasing a limb to hold a broken bone in place until healing is confirmed...

, or compartment syndrome

Compartment syndrome

Compartment syndrome is a limb threatening and life threatening condition, defined as the compression of nerves, blood vessels, and muscle inside a closed space within the body . This leads to tissue death from lack of oxygenation due to the blood vessels being compressed by the raised pressure...

.

Treatment

Surgery to release the fixed tissues may help with the deformity and function of the hand.

All splints, plaster and bandages that might be obstructing the circulation should be removed and fascial compartment should be opened fasciotomy

Fasciotomy

Fasciotomy or fasciectomy is a surgical procedure where the fascia is cut to relieve tension or pressure . Fasciotomy is a limb-saving procedure when used to treat acute compartment syndrome. It is also sometimes used to treat chronic compartment stress syndrome...

in incipient stage.

Prevention:

• requires restoration of blood flow;
• reduction of compartmental pressure

Management:

• proper initial splinting of hand in the function position;
• release of forearm flexors;
  • muscle slide
  • tendon lengthening;
• test for intrinsic tightness