Volkmann’s ischemic contracture is a deformity of the fingers, hand, or wrist caused by impaired circulation due to forearm trauma and compartment syndrome. Surgery is necessary to restore proper circulation and prevent permanent damage. Symptoms include numbness, paleness, and loss of strength or movement. Timely treatment is crucial to avoid permanent deformity and loss of function. Mild cases may be treated with elevation and a sling, while severe cases require surgery.
Forearm trauma that causes deformity of the fingers, hand or wrist due to impaired circulation is known as ischemic contracture of Volkmann. Often occurring in the presence of compartment syndrome, the presentation of Volkmann’s ischemic contracture can vary in its degree of severity depending on the extent of the injury. Surgery is typically done to relieve pressure and restore proper circulation to the affected area to prevent permanent deformities and loss of function.
Compartment syndrome occurs when a prolonged injury puts pressure on nerve and arterial function within the affected area. When such a compression injury affects the forearm and impairs circulation, the fingers, hand, or wrist may become deformed due to oxygen deprivation and prolonged contraction. If there is continued swelling, the compression will worsen and further restrict proper blood flow, putting the affected area at greater risk of permanent damage.
Injuries, such as fractures, often lead to symptoms associated with compartment syndrome. Individuals with this type of trauma may experience numbness and develop noticeable paleness in the affected area. Most cases of compartment syndrome that affect a limb or finger will also significantly affect the strength or ability to move the injured appendix.
Volkmann’s ischemic contracture is usually diagnosed with a visual and palpatory examination of the arm to determine the extent of swelling. Blood pressure measurements within the arm may also be taken to further assess the precise amount of nerve and arterial compression. The fingers and wrist are usually manually placed in a flexed or bent position to reduce pressure on the affected muscles and help relieve symptoms.
In ischemic Volkmann’s contracture, the affected muscles contract, or shorten, even though the affected area remains immobile due to swelling and stiffness. Depending on the extent of the muscle injury, an individual with Volkmann’s contracture may experience varying degrees of discomfort. Individuals with a mild presentation may not experience any discomfort while those with more severe presentations may develop shooting pain, pronounced discoloration, and sustained twitching of the fingers, hand, or wrist, individually or in combination.
Timely and appropriate treatment is essential for a good prognosis. If treatment is not received in a timely manner, permanent deformity and partial or complete loss of function is likely. Treatment generally involves alleviating the underlying cause of the compartment syndrome to remedy the symptoms of the contracture.
If Volkmann’s contracture is due to the presence of a minor fracture, elevation of the affected arm and use of a sling may be recommended to relieve swelling and prevent complications. For severe presentations of ischemic Volkmann’s contracture, such as those that occur with a severe fracture, crush injury, or severe burn, surgery may be required to relieve pressure on arterial nerve and muscle structures and prevent permanent deformities and complications. Severe cases of Volkmann’s contracture may also require reconstructive surgery to stretch the muscles and restore function to the affected area.
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