By means of muscle transplantation, this long flexor capability can be restored, which leads to a major improvement in hand function. Identif ying and r eleasing the incr eased intracompartment pressure before the irreversible ischaemic damage sets in can best prevent this problem. About volkmanns ischemic contracture penn medicine. Volkmanns ischemic contracture is the result of an untreated ischemic injury that causes muscle and nerve damage in the involved compartment of the extremity. With muscle necrosis and shortening and tightening of the long digital flexors, grip is impossible. A volkmann ischemic contracture refers to a complex and variable flexion deformity involving distal limbs typically the wrist and fingers resulting from fibrosis and contracture of flexor muscles clinical presentation. Commonly known as volkmanns ischemic contracture, the affected limb often becomes dysfunctional and painful, and may lose sensibility. Retraction of the flexor profundus muscles of the ring and middle fingers due to a severe injury at the level of. The volkmann ischemic contracture of the forearm is preventable article pdf available in european journal of trauma and emergency surgery 335. Fibrotic contracture of skeletal muscle can follow weeks or months after the severe ischemic insult of compartment syndrome. Volkmann ischemic contracture is the end result of prolonged ischemia, is associated with irreversible tissue necrosis, and has a spectrum of presentations. Results of neurolysis in established upper limb volkmanns ischemic. Volkmann ischaemic contracture radiology reference.
The disorder may be caused by the pressure of bandages, a tourniquet, or splints after a fracture. Volkmann contracture an overview sciencedirect topics. She was admitted in local hospital where the clinical examination and x ray were made and they confirmed the. Compartment syndromes and volkmann contracture clinical gate. Volkmann ischemic contracture is a sequela of untreated or inadequately treated compartment syndrome in which necrotic muscle and nerve tissue has been replaced with fibrous tissue. Volkmann ischemic contracture volkmann ischemic contracture is the end result of prolonged ischemia, is associated with irreversible tissue necrosis, and has a spectrum of presentations. The lesions are present at birth and characterised as bullae that quickly burst into deep ulcers evolving to necrotic areas. Volkmanns ischemic contracture vic is a complex and variable flexion deformity of wrist and fingers resulting from fibrosis and contracture of flexor muscles of. A volkmann ischaemic contracture refers to a complex and variable flexion deformity involving distal lumbes typically the wrist and fingers resulting from fibrosis and contracture of flexor muscles clinical presentation. Once contracture is established, it challenges the most expert reconstructive surgical treatment. Volkmann contracture occurs when there is a lack of blood flow ischemia to the.
Ischaemic contracture may affect a single finger or the entire forearm flexor. The malpositioning of the limb, the constriction by amniotic band, the presence of. It is a very rare condition in the newborn and a specific cause in this age is unknown. The basis for vic is compartment syndrome that can develop from swelling of the muscles and soft tissues that are contained in. On physical examination, pain accentuated by passive stretching seems to be the most reliable finding. Volkmanns contracture is a permanent flexion contracture of the hand at the wrist, resulting in a clawlike deformity of the hand and fingers. He was treated with ktm and a bamboo splint was applied. This case report describes about a case of a year old male child with volkmanns ischemic contracture of left forearm following a fall on the granite stone.
Volkmanns contracture contraction of the fingers and sometimes of the wrist, or of analogous parts of the foot, with loss of power, after severe injury or improper use of a tourniquet or cast in the region. It is caused by ischemic injury to the deep tissues enclosed in the tight unyielding osteofacial compartments secondary to neglected acute compartment syndrome. Volkmann ischemic contracture in a newborn bmj case reports. It occurs in the intrauterine period and arises due to mechanical compression of the limb. Volkmann contracture occurs when there is a lack of blood flow ischemia to the forearm. Volkmanns ischemic contracture with atrophic nonunion of. Compartment syndrome and volkmann ischemic contracture. The results of a study of a series of 128 patients with volkmanns ischemic contracture, therefore, are considered of sufficient interest to present here.
Volkmanns contracture is a hand, wrist or finger deformity caused by trauma, such as fractures, crush injuries, arterial injuries or burns, which cause irreversible muscle death. J, hiroshima, japan from the department of orthopaedic surgery, hiroshima universi. Volkmanns ischemic contracture of the foot and ankle. School of medicine, hiroshima the disease first described by volkmann in 1881 is generally considered to result from spasm of the main ar. Volkmanns ischemic contracture probably is not as rare as it would appear to be. These photographs show some peculiar situations in ischemic muscle contracture at the forearm. The clinical presentation of volkmann contracture includes what is commonly referred to as the five ps. K, 7 years old, had sustained a supracondylar fracture of the left elbow after the fall on the left hand with elbow extended. Volkmann ischemic contracture multimedia encyclopedia. Volkmanns contracture is the contraction of the fingers and someti mes of th e wrist, or of analogous.
In the upper extremity, this includes elbow flexion, forearm pronation, wrist flexion, thumb flexion and adduction, digital. Treatment of established cases of volkmanns ischemic contracture vic of upper limb is very tedious. Volkmanns ischemic contracture vic is a complex and variable flexion deformity of wrist and fingers resulting from fibrosis and contracture of flexor muscles of forearm. Even though not a dangerous medical condition, severe cases may necessitate surgery if reaching the point of hindering everyday. Volkmann ischemic contracture is a deformity of the hand, fingers, and wrist caused by injury to the muscles of the forearm. This has led to a compartment syndrome that has progressed to the classic picture of volkmanns ischemic contracture. Introduction volkmann s ischaemic contracture is a devastating condition with serious motor and sensory functional implications for the affected limb. Skeletal trauma is the most likely cause of an acute compartment syndrome of the forearm.
Volkmanns contracture also called volkmann ischemic contracture, is a deformity of the hand, fingers, and wrist caused by fibrosis and contracture of the forearm 1. Compartment syndrome volkmann ischemic contracture. Volkmanns ischemic contracture with atrophic nonunion of ulna. Volkmanns ischemic contracture causes significant functional impairment, particularly in the upper extremity. Educational video with case example describing the condition of volkmanns ischemic contraction during childhood. A fasciotomy may be required to reduce pressure in the muscle compartment. Volkmann contracture is a deformity of the hand, fingers, and wrist caused by injury to the muscles of the forearm. Treatment of established volkmann s contracture 927 the comparatively rare case of proximal and distal involvement requires a brief separate discussion. Ochsner, prevention of ischemic gangrene following surgical operations upon major peripheral arteries by chemical section of cervicodorsal and lumbar sympathetics ann. Volkmann contracture or volkmann ischemic contracture is a permanent shortening contracture of forearm muscles, usually resulting from injury, that gives rise to a clawlike deformity of the hand, fingers, and wrist. In the upper extremity, compartment syndrome is most common in the forearm. Medline, embase and scopus databases were searched using the mesh terms volkmanns ischaemicischemic contracture and compartment.
This case demonstrates the results and follow up of conservative physiotherapy. The contracture follows a supracondylar fracture in which there has been circulatory embarrassment. Volkmann contracture uf health, university of florida health. Volkmanns ischemic contracture is the end result of prolonged ischemia of the muscles and nerves in an extremity. Treatment of established volkmanns contracture by kenya tsuge, m. To share our experience of postcircumferential volkmanns ischemic contracture vic of the forearm seen in our setup. Congenital volkmann ischemic contracture cvic is an exceedingly rare neonatal compartment syndrome caused by intrauterine ischemia and external compression.
Volkmann ischemic contracture is the end result of prolonged. Causes volkmann contracture occurs when there is a lack of blood flow ischemia to the forearm. In the past, this type of contracture resulted from a supracondylar fracture of the humerus in children with a missed brachial artery injury. National orthopedic hospital, bahawalpur, pakistan. Volkmanns ischemic contracture is caused by ischemic injury to the deep tissues enclosed in the tight unyielding osteofacial compartments secondary to neglected acute compartment syndrome. Any fracture in the elbow volkmqnn or upper arm may lead to volkmanns ischemic contracture, but it is especially associated with supracondylar fracture of the humerus. Any fracture in the elbow volkmqnn or upper arm may lead to volkmann s ischemic contracture, but it is especially associated with supracondylar fracture of the humerus. Volkmanns ischemic contracture was first described by volkmann in 1881 17. Pdf the volkmann ischemic contracture of the forearm is. Volkmann s ischaemic contracture is a description of compartment syndrome in the forearm. Volkmann contracture, disorder of the wrist and hand in which the hand and fingers become fixed in a characteristic bent position. A volkmanns contracture is deformity of the hand, fingers, and wrist which occurs as a result of a trauma such as. The number of deformities can occur where in the upper extremity this includes elbow flexion, forearm pronation, wrist flexion, thumb flexion and adduction, digital. Volkmann ischemic contracture health encyclopedia uf.
Introduction volkmanns ischemic contracture is a condition which is characterized by ischemic necrosis of structures in the forearm extending to lower arm and hand and subsequent crippling contractures associated with varying degrees of neurologic deficit. Ischaemic contracture of the hand is defined as sequelae of ischaemic injur y to the muscle and ner ves of the limb. Volkmann ischemic contracture syndrome consists of ischemic neuromuscular and skin lesions due to increased intracompartment pressure. Compartment syndrome is an emergency and before discussing chronic compartment syndrome, it is important to understand acute compartment syndrome. Volkmanns ischemic contracture is the result of unrecognized or inadequately treated compartment syndrome of the forearm, causing muscle ischemia, necrosis, and ultimately contracture of the hand see fig. Classification of established and the program for its. Etiologic findings and incidence compartment syndrome in the upper extremity is most com. Passive extension of fingers is restricted and painful. Since the period of volkmann, various experimental.
755 715 1438 647 1282 683 313 570 1456 793 209 1220 171 1049 322 920 481 472 56 738 559 527 1203 391 274 452 820 918 1058 1466 643 630