Volkmann's contracture
| Volkmann's contracture | |
|---|---|
 Ulnar and radial arteries. Deep view. (Musculature and muscles of forearm are illustrated. However, a more proximal injury, such as a supracondylar fracture of the humerus injuring the brachial artery, may be the cause of the ischemia leading to the 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. Volkmann's Ischemic Contracture is the direct result of undiagnosed Compartment Syndrome. 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 commonly caused due to supracondylar fracture of the humerus.
Volkmann's contracture results from acute ischaemia/necrosis of the muscle fibres of the flexor group of muscles of the forearm, especially M. flexor digitorum profundus and M. flexor pollicis longus which becomes fibrotic and short.
It 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 fracture of forearm bones which cause profuse bleeding from major blood vessels of forearm.
Treatment
Surgery to release the fixed tissues may help with the deformity and function of the hand.
Prevention:
- requires restoration of blood flow;
- reduction of compartmental pressure
All splints, plaster and bandages that might be obstructing the circulation should be removed and fascial compartment should be opened (fasciotomy) in the incipient stage.
Management:
- proper initial splinting of hand in the function position;
- release of forearm flexors;
- muscle slide
- tendon lengthening;
- test for intrinsic tightness
- free functional muscle transfer
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
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