What is Volkmann's Ischemic Contracture?

J.M. Willhite

Trauma to the forearm that results in digit, hand or wrist deformity as the result of impaired circulation is known as Volkmann’s ischemic contracture. Often occurring in the presence of compartment syndrome, the presentation of Volkmann’s ischemic contracture may vary in its degree of severity depending on the extent of injury. Surgery is generally performed to alleviate pressure and restore proper circulation to the affected area to prevent permanent deformity and loss of functionality.

A sling may be recommended to alleviate swelling associated with a Volkmann's contracture.
A sling may be recommended to alleviate swelling associated with a Volkmann's contracture.

Compartment syndrome occurs when a sustained injury increases pressure on nerve and arterial function within the affected area. When such a compressive injury affects the forearm and impairs circulation, the digits, hand or wrist may become deformed as a result of oxygen deprivation and prolonged contraction. In the presence of continued swelling, the compression will worsen and further restrict proper blood flow, placing the affected area at an increased risk for permanent damage.

People with Volkmann’s ischemic contracture may develop excruciating pain.
People with Volkmann’s ischemic contracture may develop excruciating pain.

Injuries, such as fractures, often result in the onset of symptoms associated with compartment syndrome. Individuals with this type of trauma may experience numbness and develop noticeable paleness in the affected area. Most instances of compartment syndrome that affect a limb or digit will also significantly affect one’s strength or ability to move the injured appendage.

Trauma to the wrist may make it difficult to locate the radial pulse.
Trauma to the wrist may make it difficult to locate the radial pulse.

Volkmann’s ischemic contracture is generally diagnosed with a visual and palpatory examination of the arm to determine the extent of swelling. Measurements may also be taken to evaluate the blood pressure within the arm to further assess the precise amount of nerve and arterial compression. The fingers and wrist are usually manually placed into a flexion, or bent, position to decrease the pressure on the affected muscles and help ease symptoms.

Severe cases of Volkmann's contracture may necessitate reconstructive surgery.
Severe cases of Volkmann's contracture may necessitate reconstructive surgery.

In the presence of Volkmann’s ischemic contracture, the affected muscles contract, or shorten, even though the affected area remains immobile due to swelling and rigidity. Depending on the extent of muscular injury, an individual with Volkmann’s contracture may experience varying degrees of discomfort. Individuals with a mild presentation may not experience any discomfort at all while those with more severe presentations may develop excruciating pain, pronounced discoloration and prolonged contraction of the digits, hand or wrist either individually or in combination.

Prompt, appropriate treatment is essential to a good prognosis. If treatment is not received in a timely manner, permanent deformity and a partial or complete loss of functionality is likely. Treatment generally involves the alleviation of the underlying cause for the compartment syndrome to remedy contracture symptoms.

If the Volkmann's contracture is due to the presence of a minor fracture, elevation of the affected arm and the use of a sling may be recommended to alleviate swelling and prevent complications. For severe presentations of Volkmann's ischemic contracture, such as those that occur with a severe fracture, crushing injury or severe burn, surgery may be necessary to alleviate the pressure placed on the arterial nerve and muscular structures and prevent permanent deformity and complications. Severe cases of Volkmann’s contracture may also necessitate reconstructive surgery to extend the muscles and restore functionality to the affected area.

In some cases of Volkmann’s ischemic contracture, the area becomes immobile due to rigidity and swelling.
In some cases of Volkmann’s ischemic contracture, the area becomes immobile due to rigidity and swelling.

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