Volkmann's contracture

Volkmann's contracture

Classification and external resources
Specialty	emergency medicine
ICD-10	T79.6
ICD-9-CM	958.6
DiseasesDB	13991
MedlinePlus	001221
eMedicine	orthoped/578
MeSH	D054061

Volkmann's contracture, also known as Volkmann's ischaemic contracture, is a permanent flexion contracture of the hand at the wrist, resulting in a claw-like deformity of the hand and fingers. Passive extension of fingers is restricted and painful. It is excruciatingly painful and disabling.^[1]

History

It is named after Dr. Richard von Volkmann (1830 - 1889), the 19th century German doctor who first described it,^[2] in a paper on "non-Infective Ischemic conditions of various fascial compartments in the extremities".^[3] Because the contracture occurred at the same time as the paralysis, he considered a nerve etiology to be unlikely.^[4]

Causes

Any fracture in elbow region or upper arm may lead to Volkmann's ischemic contracture, but it is especially associated with supracondylar fracture of the humerus.

Volkmann's contracture results from acute ischaemia and necrosis of the muscle fibres of the flexor group of muscles of the forearm, especially the flexor digitorum profundus and flexor pollicis longus. The muscles become fibrotic and shortened.

The condition is caused by obstruction on the brachial artery near the elbow, possibly from improper use of a tourniquet, improper use of a plaster cast, or compartment syndrome. It is also caused by fractures of the forearm bones if they cause bleeding from the major blood vessels of the forearm.

Prevention and treatment

Prevention of the condition requires restoration of blood flow after injury and reduction of compartmental pressure on the muscles. Any splints, bandages, or other devices that might be obstructing circulation must be removed. A fasciotomy may be required to reduce pressure in the muscle compartment. If the contracture occurs, surgery to release the fixed tissues may help with the deformity and function of the hand.

References

↑ Robert C. France (30 December 2003). Introduction to sports medicine & athletic training. Cengage Learning. pp. 426–. ISBN 978-1-4018-1199-0. Retrieved 15 April 2010.
↑ R. Volkmann. Die ischämischen Muskellähmungen und Kontracturen. Centralblatt für Chirurgie, Leipzig, 1881, 8: 801-803.
↑ synd/2865 at Who Named It?
↑ American Surgical Association (1913). Annals of surgery. J. B. Lippincott. pp. 555–. Retrieved 15 April 2010.

External links

-26542065 at GPnotebook
Volkmanns_contracture at the Duke University Health System's Orthopedics program

Certain early complications of trauma (T79, 958)

Certain early complications of trauma	Embolism air fat Crush syndrome / Rhabdomyolysis Contracture / Volkmann's contracture / Compartment syndrome Subcutaneous emphysema

Trauma

Principles

Assessment

Clinical prediction rules	Revised Trauma Score Injury Severity Score Abbreviated Injury Scale NACA score

Investigations	Diagnostic peritoneal lavage Focused assessment with sonography for trauma

Management

Principles	Advanced trauma life support Trauma surgery Trauma center Trauma team Damage control surgery Early appropriate care

Procedures	Resuscitative thoracotomy

Pathophysiology

Injury	MSK Bone fracture Joint dislocation Degloving Soft tissue injury Resp Flail chest Pneumothorax Hemothorax Diaphragmatic rupture Pulmonary contusion Cardio Internal bleeding Thoracic aorta injury Cardiac tamponade GI Blunt kidney trauma Ruptured spleen Neuro Penetrating head injury Traumatic brain injury Intracranial hemorrhage

Mechanism	Blast injury Blunt trauma Burn Penetrating trauma Crush injury Stab wound Ballistic trauma Electrocution

Region	Abdominal trauma Chest trauma Facial trauma Head injury Spinal cord injury

Demographic	Geriatric trauma Pediatric trauma

Complications

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