This book describes Volkmann Contracture, Diagnosis and Treatment and Related Diseases
Volkmann 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.
Causes
Volkmann 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 feeling
2.Moderate — all fingers are bent and the thumb is stuck in the palm; the wrist may be bent stuck
3.Severe — all muscles in the forearm that both flex and extend the wrist and fingers are involved
Symptoms
1.Decreased sensation
2.Paleness of the skin
3.Muscle weakness and loss
4.Deformity of the wrist, hand, fingers
Medical presentation:
1.Pain,
2.Pallor,
3.Pulselessness
4.Paresthesias
5.Paralysis
The wrist is flexed
Fingers are extended at the metacarpo-phalangeal joints and flexed at the inter-phalangeal joints
Forearm is pronated and the elbow flexed
Diagnosis:
Appearance of Contracture and hand
X-ray of the arm for fracture
Tests of the muscles and nerves for their function
Treatment
The 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 longer
For moderate contracture, the surgery is done to repair the muscles, tendons, and nerves.
The arm bones are shortened
For 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 areas
Acute stage:
All measures favoring circulation normally are of the greatest value:
1.Elevation of the part,
2.Removal of any splint or circulation bandage, and
3.Application of mild external warmth
Emergency fasciotomy is needed to avoid progression to Volkmann contracture.
Patients with compartment pressures surpassing 30 mm Hg should be sent for...