Definition of Volkmann's ischemic contracture:

Volkmann's contracture is a deformity of the hand, fingers, and wrist caused by injury to the muscles of the forearm.

Causes, incidence, and risk factors:

Volkmann's contracture occurs when there is a lack of blood flow (ischemia) to the forearm, usually caused by increased pressure that results from swelling (compartment syndrome).

Trauma to the arm, including a crush injury or fracture, can lead to swelling that compresses blood vessels and can decrease blood flow to the arm. A prolonged decrease in blood flow will injure the nerves and muscles, causing them to shorten and become stiff (scarred).

When the muscle shortens, it pulls on the joint at the end of the muscle just as it would if it were normally contracted, but because it is stiff the joint remains bent and cannot straighten. This condition is called a contracture.

In Volkmann's contracture, the muscles of the forearm are severely injured, resulting in contracture deformities of the fingers, hand, and wrist.

There are three levels of severity in Volkmann's contracture:

• Mild -- flexion contracture of two or three fingers only with no or limited loss of sensation
• Moderate -- all fingers are flexed and the thumb is stuck in the palm; the wrist may be stuck in flexion and there is usually loss of some sensation in the hand
• Severe -- all muscles in the forearm that both flex and extend the wrist and fingers are involved; this is a severely disabling condition

The injury classically associated with this condition is an elbow fracture in children. Other conditions that can cause increased pressure in the forearm include any forearm fracture, burns, bleeding disorders, excessive exercise, injection of certain medications into the forearm, and animal bites.