Volkmann's contracture, sometimes knowns as Volkmann's ischemic contracture, is a condition in which the muscles of the fingers, wrist, forearm, or a combination of the three, become shortened and stiffened. This means that the joints do not straighten, producing a deformed appearance. The muscle changes are the result of an inadequate blood supply, commonly caused by swelling inside the arm which squashes blood vessels and prevents blood flowing. Volkmann's contracture is often painful and can vary in severity from mild to severe. The condition is treated using surgery to lower the pressure inside the arm and, if carried out in time, this prevents permanent damage occurring.
Causes of a Volkmann's contracture are associated with what is called compartment syndrome, where swelling increases the pressure inside the arm. One of the most common causes is a broken elbow, frequently occurring in children. Fractures involving other bones in the forearm and swelling caused by bites and burns can also lead to compartment syndrome. Crushing injuries and bleeding can lead to increased pressure in the arm, as may tight dressings, braces or casts.
Treating a Volkmann's contracture initially involves removing anything such as a dressing which may be compressing the limb. A surgical procedure known as a fasciotomy is carried out urgently to prevent the development of a permanent contracture. Fasciotomy involves cutting through the skin and tissue, or fascia, which encloses that section of the arm in which the pressure is increased. Cutting through the surrounding tissue releases the pressure inside the arm compartment and restores blood flow. Any dead portions of muscle are cut away.
In cases where fasciotomy can not prevent Volkmann's contracture because permanent muscle contraction has already set in, other forms of treatment may still be carried out. Milder cases, where contracture only affects two or three of the fingers, may be treated with physical therapy and splints. Surgery may be performed to lengthen tendons and improve the function of the hand.
Severe cases, in which contracture has affected all of the forearm muscles that bend and straighten the wrist and fingers, could require more extensive surgery to remove damaged muscle and scar tissue. Tendon transfer procedures may be carried out, where an existing tendon is detached before being attached to a different muscle. This enables movements to be carried out which were previously not possible due to loss of muscle function following the Volkmann's contracture.
