VOLKMANN'S ISCHAEMIC CONTRACTURE

Question 1

VIC definition

Answer 1

Condition characterised by disruption of blood flow to muscle resulting in muscle necrosis, fibrosis and contractures

Question 2

Aetiology of VIC

Answer 2

Generally traumatic

1. Supracondylar humerus fracture
2. Crush injury
3. Prolonged tourniquet use

Question 3

Most common location for VIC of forearm

Answer 3

Deep anterior compartment

Question 4

Most commonly affected nerve with VIC of forearm

Answer 4

Median nerve > Ulnar nerve = lies in deep anterior compartment
Radial nerve is generally spared

Question 5

Classification of VIC of forearm

Answer 5

Tsuge classification = clinical classification with 3 stages

1. Mild
   - muscles affected = FDP
   - median and ulnar sensation = normal
2. Moderate
   - muscles affected = FDP, FPL +/- FDS
   - median and ulnar sensation = absent
3. Severe
   - muscles affected = all flexors and some extensors
   - median and ulnar complete palsies = intrinsic minus hand

Question 6

Classic contracture posture with VIC of forearm

Answer 6

1. Elbow flexion
2. Forearm pronation
3. Wrist flexion
4. Thumb adduction
5. MP hyperextension and IP flexion = intrinsic minus hand

Question 7

Goal of management with VIC

Answer 7

To restore function

Question 8

Management options with VIC

Answer 8

Nonoperative = dynamic splinting
Operative
- debridement of scar tissue
- soft-tissue release
- tendon lengthening
- tendon transfers
- free muscle transfers
- neurolysis