Volkmann ischemic

contracture

Dr.Aatif Aslam
Consultant Orthopedic surgeon
Volkmann ischemic contracture
 It is defined as ischemic necrosis of the structure
contained within volar compartment of the
forearm
 It is sequel of compartment syndrome
Etiology
 In children's supracondylar fracture
 Contusion or crush injury of forearm
 Deficit of blood supply which causes muscle and
nerve malfunction
 Animal bite
 burn
 Incidence rate is 0.5% (rare disorder)
Clinical picture
 Elbow flexion
 Forearm pronation
 Wrist flexion
 Thumb adduction
 Metacarpophalangeal joint extension
 Finger flexion
severity
 Mild contracture: results from partial ischemia of the profundus
with flexion contracture involving 2 or 3 fingers, sensory changes
usually mild or absent, intrinsic muscles and joint contracture are
absent
 Moderate contracture all flexor muscles of forearm and intrinsic
muscles involved median and ulnar sensory changes are also
present
 Sever contracture involve the flexors and extensor muscles of
forearm and sensory impairment
management
 Debridement
 Neurolysis
 Muscle sliding operation(tendon transfer)
 Two stage free gracilis transfer
Postoperative care
 Wound dressing
 Implantable Doppler probe removed at 6th or 7th
day
 Immobilized for 4 weeks
 After than range of motion exercises are begun
 Muscle function can take up to 6 months
Intrinsic muscle contracture of hand
 Littler technique Is used
 Thank you