Volkmann Contracture, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

This book describes Volkmann Contracture, Diagnosis and Treatment and Related DiseasesVolkmann contracture consists of a deformity of the hand, fingers, and wrist produced by injury to the muscles of the forearm. It results in a claw like deformity of the hand, fingers, and wrist. Volkmann ischemic contracture is more common in children. A similar disorder can occur in the foot. Volkmann portrayed a contracture of the muscles of the wrist and fingers which result from tight bandaging of the arm in the treatment of fractures about the elbow.
He believed that it was fundamentally due to ischemia of the muscles. Generally, Volkmann contractures are infrequent, with an incidence of about 0.5%. The disorder happens most often in children in the first 10 years of life, and follows injuries, mainly to the elbow, and especially those linked with pressure either internal or external. CausesVolkmann contracture happens when there is inadequate blood flow (ischemia) to the forearm.
This happens when there is increased pressure due to swelling, a disorder called compartment syndrome. Injury to the arm (a crush injury or fracture) can cause swelling that presses on blood vessels and reduces blood flow to the arm. A prolonged reduction in blood flow injures the nerves and muscles, causing them to become stiff and contracted. When the muscle contracts, it pulls on the joint at the end of the muscle like if it were normally contracted.
But because it is rigid, the joint stays crooked and stuck. This disorder is called a contracture. In Volkmann contracture, the muscles of the forearm are seriously damaged. This causes contracture deformities of the fingers, hand, and wrist. There are 3 stages of severity in Volkmann contracture:1. Mild -- contracture of 2 or 3 fingers only, with no or limited loss of feeling2. Moderate -- all fingers are bent and the thumb is stuck in the palm; the wrist may be bent stuck3.
Severe -- all muscles in the forearm that both flex and extend the wrist and fingers are involvedSymptoms1. Decreased sensation2. Paleness of the skin3. Muscle weakness and loss4. Deformity of the wrist, hand, fingersMedical presentation:1. Pain, 2. Pallor, 3. Pulselessness4. Paresthesias5. ParalysisThe wrist is flexedFingers are extended at the metacarpo-phalangeal joints and flexed at the inter-phalangeal jointsForearm is pronated and the elbow flexedDiagnosis:Appearance of Contracture and handX-ray of the arm for fractureTests of the muscles and nerves for their functionTreatmentThe goal of treatment is to help people with Volkmann contracture recover some or full use of the arm and hand.
For mild contracture, muscle stretching exercises and splinting the affected fingers may be done. Surgery may be required to make the tendons longerFor moderate contracture, the surgery is done to repair the muscles, tendons, and nerves. The arm bones are shortenedFor severe contracture, surgery is done to remove muscles, tendons, or nerves that are thickened, scarred, or dead. These are replaced by muscles, tendons, or nerves transferred from other body areasAcute stage:All measures favoring circulation normally are of the greatest value:1.
Elevation of the part, 2. Removal of any splint or circulation bandage, and3. Application of mild external warmthEmergency fasciotomy is needed to avoid progression to Volkmann contracture. Patients with compartment pressures surpassing 30 mm Hg should be sent for emergency fasciotomy. When needed, the arterial repair and fixation of the fracture should be donePhysical therapy and occupational therapy should be providedOther treatment:Muscle surgeryNerve ExplorationTendon transferTABLE OF CONTENTIntroductionChapter 1 Volkmann C...