A Volkmann ischemic contracture refers to a complex and variable flexion deformity involving distal limbs (typically the wrist and fingers) resulting from fibrosis and contracture of flexor muscles. Fracture of hinge joint (elbow) or arm outcomes this contracture. It is associated with supracondylar fracture of the humerus classically 7.
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Clinical presentation
A number of deformities can occur. In the upper extremity, this includes elbow flexion, forearm pronation, wrist flexion, thumb flexion and adduction, digital metacarpophalangeal joint extension, and interphalangeal joint flexion. The affected limb may become dysfunctional, painful and may lose sensitivity.
Pathology
It is caused by ischemic injury to the deep tissues enclosed in tight unyielding osteo-fascial compartments often secondary to neglected acute compartment syndrome or arterial emboli that are causing ischemia to the forearm 7.
Location
- forearm and wrist: classically described sites
- ankle and foot: uncommon 6
Treatment and prognosis
Therapy depends upon on extent of contracture:
- mild cases are treated with physical therapy, tendon lengthening and dynamic splinting
- moderate contracture requires neurolysis and extensor tendon transfer surgeries
- severe cases are dealt with by radical debridement of scar, followed by tendon transfer procedures 7
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