Volkmann’s Ischemic contracture is the result of an untreated ischemic injury that causes muscle and nerve damage in the involved compartment of the extremity. In the past, this type of contracture resulted from a supracondylar fracture of the humerus in children with a missed brachial artery injury. Whent the arterial flow is deficient, the muscle becomes ischemic and degenerates and dies. The clinician has a short period of time between 4-6 hours to provide a diagnosis and treatment. Without restoring the compromised circulation or performing a release of the muscle compartment, the muscle will die and the nerve will be injured permanently. The limb will become deformed, dysfunctional, and insensate which could necessitate amputation (Figure 1). Additionally, there is a severe palsy in the nerves of the involved extremity (Figure 2).
Volkmann’s Ischemic Contracture commonly occurs due to neglected compartment syndrome, crush syndrome, fractures associated with vascular injuries, and bleeding disorders. Treating this condition can be difficult and in cases of neglected compartment syndrome—early diagnosis and treatment, including fasciotomy is necessary to avoid the development of Volkmann’s Ischemic Contracture.
The most common forearm muscles affected (Figure 3) are the flexor digitorum profundus ( triangle ) —the single most commonly affected muscle, and the flexor pollicus longus (star)- which is the next most common, the flexor digitorum superficialis (rectangle), and the pronator teres (check mark).
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