Volkmann’s Ischemic Contracutre

Question 1

What is the mc population that will have volkmann’s ischemic contracture

Answer 1

Children
*fracture are the predominant cause

Question 2

What is the etiology of volkmann’s ischemic contracture

Answer 2

1. A permanent flexion contracture of the hand at the wrist resulting in a claw-like deformity of the hand and fingers
2. Occurs due to compartment syndrome in the forearm
   *typically due to trauma, surgery, splint/bandage that is too tight

Question 3

What can cause volkmann’s ischemic contracture

Answer 3

Any process that leads to increased compartmental pressure can lead to compartment syndrome then volkmann’s ischemic contracture

Question 4

What is the patho physiology of volkmann’s ischemic contracture

Answer 4

1. Trauma to the arm can lead to bleeding/swelling that compresses blood vessels and can decrease blood flow to the arm
2. Prolonged decreased blood flow will injure the nerves and muscles, causing them to shorten and stiffen
   *irreversible muscle necrosis after 4 to 6 hours
3. As the muscle shortens, it pulls on the tendon/distal attachment
   *will become a contracture

Question 5

What are the 3 levels of severity (mild)

Answer 5

Flexion contracture of 2-3 fingers only with no loss of sensation

Question 6

What are the 3 levels of severity (moderate)

Answer 6

All fingers are flexed and the thumb is stuck in the palm, wrist may be stuck in flexion and there is loss of sensation in the hand

Question 7

What are the 3 levels of severity (severe)

Answer 7

All muscles in the forearm that both flex and extend the wrist and fingers are involved
*very disabling

Question 8

What are the risk factors?

Answer 8

1. Trauma
2. Elbow fracture (supracondylar from occlusion of the brachial artery)
3. Forearm fracture
4. Burns
5. Bleeding disorders

Question 9

What is the presentation?

Answer 9

1. Pain that does not improve with rest or non-sedating pain medications and will progressively worsen

Question 10

What are the 6 ps of compartment syndrome?

Answer 10

1. Pain
2. Pallor
3. Pulselessness
4. Paresthesias
5. Paralysis (late finding)
6. Poikilothermia

Question 11

What will be found on the PE?

Answer 11

1. Decreased sensation
2. Weakness
3. Paleness of the skin
4. SEVERE pain with PROM (will be stretching out the fingers in the compartment)
5. Forearm may be tensely swollen and shiny
6. Pain with compression of forearm

Question 12

What are the diagnostic findings?

Answer 12

1. Compartment pressure monitoring
   *needle will be placed into the compartment to ensure the pressure
   * if the pressure is >45mmHg or within 30mmHg of the diastolic pressure, diagnosis of compartment syndrome is made

Question 13

What is the prognosis?

Answer 13

1. Depends upon severity and stage of disease at onset?
2. Excellent if fasciotomy is done before permanent damage

Question 14

What is the treatment?

Answer 14

1. If there is a forearm or elbow fracture
   *use sling/splint to keep the area still and raise the arm above heart level
   *remove tight dressings

Question 15

What is a fasciotomy used for>

Answer 15

To release the pressure in the forearm before any permanent injury to the muscles/nerves can occur
*wounds usually left open under sterile dressing and closed 48-72 hours
*median nerve will be decompressed

Question 16

What are the 4 C of intraoperative viability? (Of the muscle)

Answer 16

1. Color
2. Consistency
3. Contractility
4. Capacity to bleed