Orthopaedy

Volkmann’s contracture

Volkmann’s contracture is a joint ankylosis due to insufficiency of circulation of blood. The most known case of carpal contracture with claw finger position is named «clawed paw»: the wrist is in a bent position at impossibility even insignificant compression of fingers in a fist or its complete unbending.

This disease is named after the German surgeon Richard von Volkmann (1830-1899). Contracture is proof limitation of normal mobility in a joint because of its defeat, and also damage of skin, muscles, fascia, nerves, and ruptured ligaments.

Symptoms

  • Decline of elasticity of muscles.
  • Atrophy of nervous completions.
  • Joint contractures.
  • «Clawed paw».

Causes

Tissues die in default of circulations of blood in them. Elasticity of muscles strongly goes down. As a result of circulatory failure, nerve tissue is affected. Insufficiency of circulation of blood and contracture often are the result of too tight bandage which violates normal circulation of blood. Other possible cause of Volkmann’s contracture is a break or dislocation of bones of elbow joint. At displacement of separate fragments of bones there is a danger of squeezing of the blood vessels that feed the forearm, wrist and fingers.

Treatment

At the protracted violation of circulation of blood the affected muscles and nerves do not respond to treatment. It is possible to save only nearby muscles, if they were not fully affected. First of all, it is necessary to provide sufficient blood flow to the tissues again – for this it is necessary to increase blood circulation and eliminate the cause that prevents blood flow. Contrasting baths for hands are enough effective for that.

At first, the hands of patient are immersed in hot water, then – in cold. It is necessary to set joints and muscles in motion. By the special bandage it is necessary to fix the joint of wrist in the unbent position, it is so possible to mobilize muscles wrists, which have not yet fully affected, than a patient could take and retain objects.

Due to the long-term treatment of Volkmann’s contracture the first results will not appear soon, however in any case don’t despair and don’t halt treatment.

If after falling on a hand, an elbow joint or wrist joint hurts long time, it is necessary immediately to appeal to the doctor (even in case that motion in area of joint of wrist is unreserved).

If as a result of break or dislocation there is a squeezing of the blood vessels, a patient has to be operated. A doctor makes decision about the necessity of operation only after the study of radiograph.

Course of the disease

At the break of bones in area of elbow joint, bone fragments can block blood vessels, which are in an elbow bend, as a result, circulation of blood in a forearm and wrist can be violated. Muscles and nerves are not enough provided with oxygen or quite don’t get it. The products of disintegration, appearing in the process of metabolism, do not retire. Cells die. At violation of circulation of blood in muscles during 4-6 hours, tissue damage is irreversible. Elastic muscle fibers eventually replace non-elastic connective tissue. The nerves that innervate the healthy muscle, die during 12-24 hours due to insufficiency circulations of blood, in addition, they can be engaged in formation of scar. As a result of defeat of muscles and nervous completions movement of wrist and fingers becomes impossible.

Prevention

Trauma and pain in the elbow should be treated only by a qualified doctor.

Self-medication in any case not allowed. Don’t impose a pressure bandage and fix bandage on upper and lower extremities.