Volkmann's contracture is a permanent

flexion Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relativ ...

contracture In pathology, a contracture is a permanent shortening of a muscle or joint. It is usually in response to prolonged hypertonic spasticity in a concentrated muscle area, such as is seen in the tightest muscles of people with conditions like sp ...

of the

hand A hand is a prehensile, multi-fingered appendage located at the end of the forearm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs. A few other vertebrates such as the koala (which has two opposable thumbs on each "h ...

at the

wrist In human anatomy, the wrist is variously defined as (1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; "The wrist contains eight bones, roughly aligned in two rows, known as the carp ...

, resulting in a claw-like deformity of the hand and fingers. Passive extension of fingers is restricted and painful.

Causes

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

supracondylar fracture A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. This fracture pattern is relatively rare in a ...

of the

humerus The humerus (; ) is a long bone in the arm that runs from the shoulder to the elbow. It connects the scapula and the two bones of the lower arm, the radius and ulna, and consists of three sections. The humeral upper extremity consists of a r ...

. It is also caused by fractures of the forearm bones if they cause bleeding from the major blood vessels of the forearm. The condition may be caused by obstruction on the

brachial artery The brachial artery is the major blood vessel of the (upper) arm. It is the continuation of the axillary artery beyond the lower margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa ...

near the elbow, possibly from improper use of a

tourniquet A tourniquet is a device that is used to apply pressure to a limb or extremity in order to stop the flow of blood. It may be used in emergencies, in surgery, or in post-operative rehabilitation. A simple tourniquet can be made from a stick an ...

, improper use of a

plaster cast A plaster cast is a copy made in plaster of another 3-dimensional form. The original from which the cast is taken may be a sculpture, building, a face, a pregnant belly, a fossil or other remains such as fresh or fossilised footprints – ...

, or

compartment syndrome Compartment syndrome is a condition in which increased pressure within one of the body's anatomical compartments results in insufficient blood supply to tissue within that space. There are two main types: acute and chronic. Compartments of the ...

Pathophysiology

Volkmann's contracture results from acute

ischaemia Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems ...

and

necrosis Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated diges ...

of the muscle fibres of the flexor group of muscles of the forearm, especially the

flexor digitorum profundus The flexor digitorum profundus is a muscle in the forearm of humans that flexes the fingers (also known as digits). It is considered an extrinsic hand muscle because it acts on the hand while its muscle belly is located in the forearm. Togeth ...

and

flexor pollicis longus The flexor pollicis longus (; FPL, Latin ''flexor'', bender; ''pollicis'', of the thumb; ''longus'', long) is a muscle in the forearm and hand that flexes the thumb. It lies in the same plane as the flexor digitorum profundus. This muscle is un ...

. The muscles become fibrotic and shortened.

Prevention

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 Fasciotomy or fasciectomy is a surgical procedure where the fascia is cut to relieve tension or pressure in order to treat the resulting loss of circulation to an area of tissue or muscle. Fasciotomy is a limb-saving procedure when used to tre ...

may be required to reduce pressure in the muscle compartment.

Treatment

If contracture occurs, surgery to release the fixed tissues may help with the deformity and function of the hand.

History

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

References

External links

* {{Trauma , state=autocollapse Early complications of trauma Orthopedic problems