Volkmanns ischmic contrature by Dr.K.AmrithaAnilkumar

Volkmann's Ischmic Contrature is defined as a vascular injury leading to muscular infarction and subsequent Contrature. It may be caused due to supracondylar fracture of the humerus , iv fluids, chemotherapy, burns, closed forearm crushed injuries, tight plaster after reduction of fracture.

1. e n love da Homoeopathy VOLKMANN’S ISCHMIC CONTRATURE

2. VOLKMANN’S ISCHMIC CONTRATURE

3. VOLKMANNS ISCHMIC CONTRATURE DEFINITION It is a vascular injury leading to muscular infarction and subsequent contracture.

4. CAUSES Supracondylar fracture of the humerus. IV fluid chemotherapy. Burns. Closed forearm crush injuries. Tight plaster after reduction of fracture. B urns Supracondylar fracture

5. PATHOGENESIS Injury to Brachial artery Followed by infarction of forearm Flexor Muscles And injury to median nerve & ulnar nerve both by ischaemia & infarction Followed by aseptic muscles necrosis & fibrosis of flexor muscles of forearm followed by Contracture Features

6. CLINICAL FEATURES Acute phase: Pain (persistent pain in forearm, hand, fingers—ominous symptom). Pallor Puffiness (due to oedema).

7. Pulseless (absence of radial pulse; but its presence does not rule out the onset of impending contracture). Paresis Late phase Deformity Deformity (due to injury to median nerve) Wrist joint extended. Extended metacarpophalangeal joints. Flexed interphalangeal joints. Pulseless

8. Volkmann’s sign : In early stage, the fingers can be extended at the interphalangeal joints, only when the wrist is flexed fully. The fingers tend to flex if any attempt to extend the wrist is made Volkmann’s sign

9. TREATMENT In acute phase: Removal of plastic cast applied after fracture reduction. Correction of fracture. Exposure of brachial artery and application of 2.5% papaverine sulphate to relieve the spasm if any.

10. Suture of arterial tear if present, often with placement of arterial graft. Lateral incision over the deep fascia of forearm is placed to decompress the oedema. In late phase (once deformity occurs): Physiotherapy Dynamic splints. Max-Page operation : Release of flexor muscles (forearm muscles) from their origins from the bone and allowing it slide down until full extension.

11. MAX –PAGE OPERATION AFTER MAX –PAGE OPERATION

12. Excision of fibrous tissue and damaged muscles along with tendon transfer. Arthrodesis. REFERENCE SRB's Manual of Surgery by Sriram Bhat M 2. A Manual on Clinical Surgery by Das 3. A C oncise textbook of Surgery by Das

13. A Special Thanks To A Very Special Doctor