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CONDITION/DISORDER SYNONYMS

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  • Forearm, anterior compartment syndrome

  • Volkmann contracture

  • Volkmann ischemic contracture

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ICD-9-CM CODE1

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  • 958.6 Volkmann ischemic contracture

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ICD-10-CM CODE2

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  • T79.6 Traumatic ischemia of muscle

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PREFERRED PRACTICE PATTERN3

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  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

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PATIENT PRESENTATION

A 38-year-old man with a recent supracondylar humerus fracture presents with disproportionate unilateral forearm pain. He is currently experiencing tingling in the area. His radial pulse is absent. Distal phalanges are blanched tint and are cool to the touch. His wrist and fingers are in a flexed position and he has diminished sensation on the volar side of his hand.

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KEY FEATURES

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Description
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  • Flexion contracture of the wrist, resulting in claw-like deformity

  • Obstruction of brachial artery near the elbow

    • Obstruction commonly caused by compartment syndrome or fracture

  • Three levels of severity

    • Mild: Contracture of two or three fingers only, only limited sensation deficit

    • Moderate: All fingers (including thumb) contracted in flexed position; wrist may be in flexion and slight sensation loss

    • Severe: All muscles in the forearm affected (flexors and extensors)

  • Arteriolar compression occurs and causes muscle and nerve ischemia

    • Acute, sensory changes develop after 30 minutes of ischemia

    • Acute, irreversible nerve damage in 12 to 24 hours

    • Acute, irreversible muscle changes (i.e., necrosis) in 3 to8 hours

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FIGURE 168-1

Compartment syndrome. Volkmann contracture is a serious late complication of unrelieved compartment syndrome. (From Knoop KJ, Stack L, Storrow A, Jason Thurman R. The Atlas of Emergency Medicine. 3rd ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved. Photo contributor: Lawrence B. Stack, MD.)

Graphic Jump Location
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Essentials of Diagnosis
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  • Diagnosis is typically made by clinical examination and compartment pressure measurement

  • Severe pain that is not alleviated by elevation or pain medication

    • Pain increases with passive/active range of motion and compression

  • Distal pulses are diminished/absent

  • Strength and sensation are diminished

  • Edema in affected limb

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General Considerations
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  • Occurs in the flexor/volar compartment of the forearm

    • Flexor digitorum profundus becomes fibrotic and shortened

    • Flexor pollicis longus becomes fibrotic and shortened

  • Classic P’s

    • Pain

    • Pallor

    • Pulselessness

    • Paresthesias

    • Paralysis

  • Complications

    • Infection

    • Contractures

    • Deformity

    • Amputation

    • Acidosis

    • Hyperkalemia

    • Myoglobinuria

    • Acute renal failure and shock

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Demographics
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  • Younger age, high-energy/high-velocity trauma, and systemic hypotension associated with an increased risk of traumatic accident

  • More common in children

  • High-risk patients include:

    • Soft-tissue injury in males aged <35 years with bleeding disorder or receiving anticoagulants

    • Crush injury patients

    • Patients with prolonged limb compression

  • Individuals using circumferential wraps, restrictive dressings, casts, or immobilizer are at an increased risk

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CLINICAL FINDINGS

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SIGNS AND SYMPTOMS

  • Swollen and ...

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