Editing Volkmann's contracture

{{Infobox medical condition (new) 
| name            = Volkmann's contracture 
| synonyms        = Volkmann's ischaemic contracture
| image           = The practice of surgery (1910) (14756898256).jpg 
| field           = Orthopaedics
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'''Volkmann's contracture''' is a permanent [[flexion]] [[contracture]] of the [[hand]] at the [[wrist]], resulting in a claw-like deformity of the hand and fingers. Passive extension of fingers is restricted and painful.<ref name="France2003">{{cite book|author=Robert C. France|title=Introduction to sports medicine & athletic training|url=https://books.google.com/books?id=YyOCem-151sC&pg=PA426|access-date=15 April 2010|date=30 December 2003|publisher=Cengage Learning|isbn=978-1-4018-1199-0|pages=426–}}</ref>

==Signs and symptoms==
The most important signs and symptoms of [[compartment syndrome]] are observable before actual contracture. What is known as the five Ps of compartment syndrome include: [[pain]], generally the initial symptom, accompanied by pulselessness, [[pallor]], [[paralysis]], and [[Paresthesia|paraesthesias]]. Pain will likely also increase upon extension of the affected limbs hands and fingers, which is one of the earliest signs of compartment syndrome and should urgently be followed up by an exam to look for potential development of Volkmann contracture itself. Palpating for tissue firmness in the forearm, and the pulse volume and character of the [[radial artery]], also reflects the degree of compartment syndrome.<ref>{{Citation |last=Mirza |first=Taaha M. |title=Volkmann Contracture |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK557754/ |work=StatPearls |access-date=2023-04-24 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32491686 |last2=Taqi |first2=Muhammad}}</ref>

==Causes==
Any fracture in the elbow region or upper arm may lead to Volkmann's ischemic contracture, but it is especially associated with [[supracondylar fracture]] of the [[humerus]]. It is also caused by fractures of the forearm bones if they cause bleeding from the major blood vessels of the forearm.{{Citation needed|date=May 2021}}

The condition may be caused by obstruction on the [[brachial artery]] near the elbow, possibly from improper use of a [[tourniquet]], improper use of a [[Orthopedic cast|plaster cast]], or [[compartment syndrome]].{{Citation needed|date=May 2021}}

== Pathophysiology ==
Volkmann's contracture results from acute [[ischaemia]] and [[necrosis]] of the muscle fibres of the flexor group of [[Forearm#Muscles|muscles of the forearm]], especially the [[Flexor digitorum profundus muscle|flexor digitorum profundus]] and [[Flexor pollicis longus muscle|flexor pollicis longus]]. The muscles become fibrotic and shortened.{{Citation needed|date=May 2021}}
==Prevention==
Prevention of the condition requires restoration of blood flow after injury and reduction of compartmental pressure on the muscles. Any splints, bandages, or other devices that might be obstructing circulation must be removed.{{Citation needed|date=May 2021}}

A [[fasciotomy]] may be required to reduce pressure in the muscle compartment.<ref>{{Cite journal |last=Gordon |first=Wade T. |last2=Talbot |first2=Max |last3=Shero |first3=John C. |last4=Osier |first4=Charles J. |last5=Johnson |first5=Anthony E. |last6=Balsamo |first6=Luke H. |last7=Stockinger |first7=Zsolt T. |date=2018-09-01 |title=Acute Extremity Compartment Syndrome and the Role of Fasciotomy in Extremity War Wounds |url=https://pubmed.ncbi.nlm.nih.gov/30189076/ |journal=Military Medicine |volume=183 |issue=suppl_2 |pages=108–111 |doi=10.1093/milmed/usy084 |issn=1930-613X |pmid=30189076|doi-access=free }}</ref>

== Treatment ==
If contracture occurs, surgery to release the fixed tissues may help with the deformity and function of the hand. In established stage reconstructive surgery may be needed. {{Citation needed|date=September 2024}}

==History==
It is named after [[Richard von Volkmann]] (1830–1889), the 19th century German doctor who first described it,<ref>R. Volkmann. ''Die ischämischen Muskellähmungen und Kontracturen.'' Centralblatt für Chirurgie, Leipzig, 1881, 8: 801–803.</ref> in a paper on ''"non-Infective Ischemic conditions of various fascial compartments in the extremities"''.<ref>{{WhoNamedIt|synd|2865}}</ref> Because the contracture occurred at the same time as the paralysis, he considered a nerve cause to be unlikely.<ref name="Association1913">{{cite book|author=American Surgical Association|title=Annals of surgery|url=https://books.google.com/books?id=avcAAAAAYAAJ&pg=PA555|access-date=15 April 2010|year=1913|publisher=J. B. Lippincott|pages=555–}}</ref>

==References==
{{reflist}}

== External links ==
{{Medical resources
|   DiseasesDB     = 13991 
|   ICD10          = {{ICD10|T|79|6|t|79}} 
|   ICD9           = {{ICD9|958.6}} 
|   ICDO           = 
|   OMIM           = 
|   MedlinePlus    = 001221 
|   eMedicineSubj  = orthoped 
|   eMedicineTopic = 578 
|   MeshID         = D054061 
}}

{{Trauma |state=autocollapse}}

[[Category:Early complications of trauma]]
[[Category:Orthopedic problems]]