Review Question - QID 106255

This child is suffering from a Volkmann's contracture secondary to obstruction of the brachial artery, most likely caused by improper, tight application of the plaster cast to stabilize his supracondylar fracture.

Volkmann's ischemic contracture results from acute ischemic necrosis of the forearm flexors, especially the flexor digitorum profundus and flexor pollicus longus. This injury results in a permanent flexor contraction of the wrist and deformity of the hand and fingers. First described by Dr. Richard von Volkmann, this contracture was found to be independent of nerve injury because it manifested at the same time as paralysis.

Mubarak and Caroll review Volkmann's contracture in children pointing out that supracondylar fractures of the elbow resulting in Volkmann's contracture frequently have both an arterial injury and a compartment syndrome.

Hovius and Ultee present guidance on the prevention and treatment of Volkmann's contracture reporting that optimal treatment depends largely on proper evaluation of the extent of pathology. They affirm that the most important measures concerning Volkmann's ischemic contracture, are attempts to prevent the contracture from developing with simply monitoring or immediate repair of high-risk injuries and compartment syndromes.

Figure A shows a radiograph of a closed, comminuted supracondylar fracture. Figure B shows a Volkmann's ischemic contracture.

Incorrect Responses:
Answer 1-3: Volkmann's contracture forms independently of nerve injuries, although ulnar neuropathy can sometimes present with claw-like deformities.
Answer 5: Axillary artery compression/obstruction is not the etiology of Volkmann's contracture.