Updated: 12/20/2017

Volkmann Ischemic Contracture

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Topic
Snapshot
  • A 50-year-old man presents to his physician’s office two months after he was treated for compartment syndrome in his forearm. He reports having difficulty using his hands. Physical exam shows that his right fingers and wrist are flexed into a claw-like contracture. He is referred for surgical correction.
Introduction
  • Clinical definition
    • claw-like deformity of the hands with permanent shortening of the forearm muscles, resulting from ischemia and necrosis of the forearm muscles
  • Epidemiology
    • demographics
      • adults
    • risk factors
      • compartment syndrome
      • supracondylar humerus fracture   
      • crush injuries
      • bleeding disorders
  • Pathogenesis
    • ischemia and necrosis of the forearm muscles from
      • obstruction of the brachial artery (compartment syndrome or restrictive cast)
      • fracture of the forearm bones causing bleeding from the major blood vessels
    • this results in scarring, stiffening, and shortening of the forearm muscles, causing the contracture
Presentation
  • Symptoms
    • inability to extend fingers or wrist or open hand
  • Physical exam
    • flexion contracture of several or all fingers
    • wrist may also be involved
    • may have ↓ sensation
    • pain with passive extension of fingers or wrist
    • unable to passively extend fingers or wrist fully
Studies
  • Making the diagnosis
    • most cases are clinically diagnosed
Differential
  • Pseudo-Volkmann contracture
    • distinguishing factors
      • primarily in children
      • forearm muscles are a normal length
Treatment
  • Conservative
    • physical and occupational therapy
      • indication
        • for all patients
  • Operative
    • surgical treatment
      • indication
        • to restore function of the hand
Complications
  • Permanent contracture of hands
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Questions (1)

(M1.MK.14.40) A 5-year-old boy presents to the emergency department following an ATV accident in which he sustained an arm fracture (see Figure A). The fracture was reduced and a plaster cast was molded firmly to the arm. The child returns to clinic two weeks later, where he is found to have a flexion contracture of the hand at the wrist (see Figure B). Passive extension of his fingers in extremely painful. What is the primary mechanism that caused this deformity? Tested Concept

QID: 106255
FIGURES:
1

Ulnar nerve injury

18%

(4/22)

2

Radial nerve injury

50%

(11/22)

3

Median nerve injury

14%

(3/22)

4

Obstruction of the brachial artery

14%

(3/22)

5

Obstruction of the axillary artery

5%

(1/22)

M 2 E

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Evidence (2)
VIDEOS (1)
Topic COMMENTS (2)
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