Volkmann Contracture

Classification

Ischemia is defined as cell death due to lack of blood supply. The intensity of injury depends on the type of cell and its energy requirements.

Ischemic injuries are classified in various ways. One is according to the severity of involvement:

They may also be classified according to the structures involved:

Tsuge's classification comprises three types, according to the extent and the muscle groups involved.

Anatomy

The brachial artery branches into the radial and ulnar arteries. The radial artery is superficially positioned, whereas the ulnar artery is deeply placed, passing deep into the pronator teres muscles. The ulnar artery gives rise to the common interosseous artery, which immediately divides into the anterior and posterior interosseous branches. The anterior interosseous artery provides blood supply to the flexors of the forearm and hand.

Causes

Ischemic contracture may be caused by the following:

• Fracture
• Compartmental syndrome
• Tight bandages
• Arterial embolus
• Arterial insufficiency
• Improper use of a tourniquet
• Improper use of a plaster cast

Volkmann contracture occurs when there is insufficient blood supply (ischemia) to the forearm and is the end result of an untreated or relatively inadequately decompressed compartment syndrome in which ischemic necrosis of muscles has developed. The key factor in all cases of ischemic contracture is reduction in compartment size or increase in the content of a closed, uncompromising osteofascial compartment, which is enough to cause occlusion of small vessels.

The blockade immediately results in ischemia of the nerve and muscle. If the pressure is not relieved in time, it may result in damage to muscle contracture and nerves.

Decrease in the compartment size can be attributed to the following causes:

• Constrictive casts and dressings
• Persistent localized external pressure
• Injuries due to heat
• Burn Escher
• Plastic surgery of facial defects

This can also be attributed to an increase in compartment content resulting from hemorrhage, bleeding diathesis, or anticoagulation.

Diagnosis

The hallmark symptom of Volkmann contracture is pain that does not improve with rest or nonsedative analgesics. It will continue to get worse as time passes, and if the pressure is allowed to persist, there will be decreased sensation and weakness.

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