Clinical note Multidisciplinary conservative management in classical Volkmann's contracture: a case report

This clinical note describes the case of a nine-year-old girl with classical Volkmann's contracture of the left forearm. The report demonstrates the results and follow-up of conservative orthotic management used as a mode of treatment by a multidisciplinary team. When using an orthosis it is essential to check regularly to attain the desired result. Introduction In an anatomic compartment, muscles are enclosed in ossofascial, relatively noncompliant boundaries. The forearm consists of three compartments; the volar and dorsal compartments and a mobile wad on the lateral side of the radius (Naidu and Heppenstall, 1994). When pressure rises in a closed fascial space, the circulation is compromised and capillary blood perfusion of intercompartmental tissues, such as muscles and nerves, can be reduced. This condition is defined as a compartment syndrome and can exist without any major arterial injury (Mubarak and Carrol, 1979; Hargens and Mubarak, 1981). If this remains untreated, Volkmann's contracture can occur, as the end result of the ischaemic injury. Patients suffering this severe complication typically present with a flexed elbow, pronated forearm, flexed wrist, adducted thumb, extended metacarpal phalangeal joints and flexed fingers (Mubarak and Carrol, 1979; Zuker, 1989). The management of such established contractures is very complex. The patient described in this case was treated with a combined stretching and orthotic programme.