VOLKMANN’S ISCHEMIC CONTRACTURE;

POST-CIRCUMFERENTIAL CONTRACTURE OF THE FOREARM

Abstract

Objective: To share our experience of post-circumferential Volkmann’s Ischemic
Contracture (VIC) of the forearm seen in our setup. Design: A descriptive case series study.
Setting: National Orthopedic Hospital, Bahawalpur, Pakistan. Period: January 2005 to
December 2013. Methodology: A total of 42 patients were registered during the study period.
Patients with VIC of the forearm resulting from direct circumferential compression were included
in the study. Patients who developed VIC of forearm indirectly secondary to arm pathology or
other causes were excluded from the study. Assessment was made by detailed history, clinical
examination and radiographs of the involved extremity. The age, sex, duration, side and type of
contracture, length and width of forearm and resulting deformities were all documented on a
detailed proforma. Patients were categorized into three types accordingly. Results: Forty two
patients comprising 29 males and 13 females were seen. Their ages ranged from 1 to 53 years
with mean age of 14.47 years. Duration of established VIC of the forearm after insult ranged from 3
months to 6 years with mean duration of 2 ½ years. Most frequent type of contracture was
moderate variety seen in 19 patients (45.23%) with 14 cases on the right and 5 cases on left side
followed by severe varieties which were present in 13 patients (31%) with 10 cases on the right
and 3 cases on left side. Mild contractures were found in 10 patients (23.9%) with 6 cases on the
right and 4 cases on left side. In 26 of 42 patients, a difference in forearm length that ranged from
79% to 94% (mean, 80%) was observed. Majority of cases (37 cases) of VIC occurred after TBS for
radius and ulna fractures while in the remaining 5 cases, contractures of forearm occurred due to
tight plaster of paris (POP) splint. Conclusions: Post-circumferential forearm contractures after
Traditional Bone Setters (TBS) are common in our society. Community awareness through health
education and conducting medical camps and seminars might play a role in decreasing the
influence of TBS.