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Volkmann Contracture Treatment & Management

  • Author: John A Kare, MD; Chief Editor: Jason H Calhoun, MD, FACS  more...
Updated: Sep 21, 2015

Approach Considerations

Initial treatment for Volkmann contracture consists of removal of occlusive dressings or splitting or removal of casts. Analgesics are the mainstay for symptomatic relief in chronic cases.

Emergency fasciotomy is required to prevent progression to Volkmann contracture. There is some disagreement regarding which compartment pressure readings are indications for fasciotomy; however, most agree that patients with compartment pressures exceeding 30 mm Hg should be taken to the operating room for emergency fasciotomy.[16] There are no absolute contraindications to immediate decompression for Volkmann contracture in the acute setting.

Both physical therapy and occupational therapy are vital to the improvement of range of motion and the return of function in patients with Volkmann contracture.


Surgical Therapy

To prevent the development of Volkmann contracture, decompression is performed via the volar or the dorsal approach. Decompression of the medial nerve throughout its course is essential, especially in the following high-risk areas[17, 18, 19, 20, 21, 22, 23] :

  • Deep to the lacertus fibrosus
  • Between the humeral and ulnar heads of the pronator teres, the proximal arch, and the deep fascial surface of the flexor digitorum superficialis
  • In the carpal tunnel

Once contracture has occurred, treatment depends on the type of Volkmann contracture present, as follows:

  • Mild - Dynamic splinting, physical therapy, tendon lengthening, and slide procedures are used to improve function[24]
  • Moderate - Tendon slide, neurolysis (M and U), and extensor transfer procedures are used
  • Severe - More extensive and radical intervention is required, often involving extensive debridement of damaged muscle with multiple releases of scar tissue and salvaging procedures

Severe contractures necessitate the release of contracted tendons at the musculotendinous junction and tendon transfers performed at a later date. The preferred transfers involve the brachioradialis, which is often transferred to the flexor pollicis longus to regain thumb motion. For finger flexion, the extensor carpi radialis longus is commonly transferred to the flexor digitorum profundus. If no motor function is present secondary to muscle necrosis and fibrosis, free muscle can be used for transplantation.[25]

Muscle viability in Volkmann contracture can be assessed by using what commonly is referred to as the four Cs: color, consistency, contractility, and capacity to bleed.


Complications related to fasciotomy for Volkmann contracture include the following[26, 27] :

  • Altered sensation within the margins of the wound (77%)
  • Dry, scaly skin (40%)
  • Pruritus (33%)
  • Discolored wounds (30%)
  • Swollen limbs (25%)
  • Tethered scars (26%)
  • Recurrent ulceration (13%)
  • Muscle herniation (13%)
  • Pain related to the wound (10%)
  • Tethered tendons (7%)

The appearance of the scars can affect patients. In one study, 23% of patients kept the wound covered, 28% changed hobbies, and 12% changed their occupation.[26]

Contributor Information and Disclosures

John A Kare, MD Assistant Professor of Emergency Medicine, Charles R Drew University of Medicine and Science; Director of Research, Department of Emergency Medicine, Martin Luther King Jr/Charles R Drew Medical Center

John A Kare, MD is a member of the following medical societies: American Academy of Emergency Medicine, Emergency Medicine Residents' Association, American Medical Student Association/Foundation

Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS Department Chief, Musculoskeletal Sciences, Spectrum Health Medical Group

Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Michigan State Medical Society, Missouri State Medical Association, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, Texas Orthopaedic Association, Musculoskeletal Infection Society

Disclosure: Nothing to disclose.


Samuel Agnew, MD, FACS Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville College of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center

Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jeffrey L Visotsky, MD Assistant Professor, Department of Clinical Orthopedic Surgery, Northwestern University, The Feinberg School of Medicine

Jeffrey L Visotsky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American College of Physician Executives, American College of Surgeons, American Medical Association, American Society for Surgery of the Hand, Arthroscopy Association of North America, Chicago Medical Society, and Illinois State Medical Society

Disclosure: Depuy Consulting fee Speaking and teaching; Pegasus Honoraria Board membership

  1. Oprel PP, Eversdijk MG, Vlot J, Tuinebreijer WE, den Hartog D. The acute compartment syndrome of the lower leg: a difficult diagnosis?. Open Orthop J. 2010 Feb 17. 4:115-9. [Medline]. [Full Text].

  2. Shuler MS, Reisman WM, Kinsey TL, Whitesides TE Jr, Hammerberg EM, Davila MG, et al. Correlation between muscle oxygenation and compartment pressures in acute compartment syndrome of the leg. J Bone Joint Surg Am. 2010 Apr. 92(4):863-70. [Medline].

  3. Myers RA. Hyperbaric oxygen therapy for trauma: crush injury, compartment syndrome, and other acute traumatic peripheral ischemias. Int Anesthesiol Clin. 2000 Winter. 38(1):139-51. [Medline].

  4. Hargens AR, Mubarak SJ. Current concepts in the pathophysiology, evaluation, and diagnosis of compartment syndrome. Hand Clin. 1998 Aug. 14(3):371-83. [Medline].

  5. Harris IE. Supracondylar fractures of the humerus in children. Orthopedics. 1992 Jul. 15(7):811-7. [Medline].

  6. O'Hara LJ, Barlow JW, Clarke NM. Displaced supracondylar fractures of the humerus in children. Audit changes practice. J Bone Joint Surg Br. 2000 Mar. 82(2):204-10. [Medline].

  7. Ragland R 3rd, Moukoko D, Ezaki M, Carter PR, Mills J. Forearm compartment syndrome in the newborn: report of 24 cases. J Hand Surg [Am]. 2005 Sep. 30(5):997-1003. [Medline].

  8. Flynn JM, Jones KJ, Garner MR, Goebel J. Eleven years experience in the operative management of pediatric forearm fractures. J Pediatr Orthop. 2010 Jun. 30(4):313-9. [Medline].

  9. Erdös J, Dlaska C, Szatmary P, Humenberger M, Vécsei V, Hajdu S. Acute compartment syndrome in children: a case series in 24 patients and review of the literature. Int Orthop. 2010 Apr 18. [Medline].

  10. Deeney VF, Kaye JJ, Geary SP. Pseudo-Volkmann's contracture due to tethering of flexor digitorum profundus to fractures of the ulna in children. J Pediatr Orthop. 1998 Jul-Aug. 18(4):437-40. [Medline].

  11. McDonald S, Bearcroft P. Compartment syndromes. Semin Musculoskelet Radiol. 2010 Jun. 14(2):236-44. [Medline].

  12. Prayson MJ, Chen JL, Hampers D, Vogt M, Fenwick J, Meredick R. Baseline compartment pressure measurements in isolated lower extremity fractures without clinical compartment syndrome. J Trauma. 2006 May. 60(5):1037-40. [Medline].

  13. Blakemore LC, Cooperman DR, Thompson GH. Compartment syndrome in ipsilateral humerus and forearm fractures in children. Clin Orthop. 2000 Jul. (376):32-8. [Medline].

  14. McGraw JJ, Akbarnia BA, Hanel DP. Neurological complications resulting from supracondylar fractures of the humerus in children. J Pediatr Orthop. 1986 Nov-Dec. 6(6):647-50. [Medline].

  15. Garner A, Handa A. Screening Tools in the Diagnosis of Acute Compartment Syndrome. Angiology. 2010 May 12. [Medline].

  16. Collinge C, Kuper M. Comparison of three methods for measuring intracompartmental pressure in injured limbs of trauma patients. J Orthop Trauma. 2010 Jun. 24(6):364-8. [Medline].

  17. Botte MJ, Gelberman RH. Acute compartment syndrome of the forearm. Hand Clin. 1998 Aug. 14(3):391-403. [Medline].

  18. Domanasiewicz A, Jablecki J, Kocieba R, Syrko M. Modified Colzi method in the management of established Volkmann contracture--the experience of Trzebnica Limb Replantation Center (preliminary report). Ortop Traumatol Rehabil. 2008 Jan-Feb. 10(1):12-25. [Medline].

  19. Stevanovic M, Sharpe F. Management of established Volkmann's contracture of the forearm in children. Hand Clin. 2006 Feb. 22(1):99-111. [Medline].

  20. Wilson PD. Capsulectomy for the relief of flexion contractures of the elbow following fracture. 1944. Clin Orthop. 2000 Jan. (370):3-8. [Medline].

  21. Sharma P, Swamy MK. Results of the Max Page muscle sliding operation for the treatment of Volkmann's ischemic contracture of the forearm. J Orthop Traumatol. 2012 Aug 2. [Medline].

  22. Zuker RM, Bezuhly M, Manktelow RT. Selective fascicular coaptation of free functioning gracilis transfer for restoration of independent thumb and finger flexion following Volkmann ischemic contracture. J Reconstr Microsurg. 2011 Sep. 27(7):439-44. [Medline].

  23. Tang H, Zhang SC, Tan ZY, Zhu HW, Zhang QL, Li M. Functional reconstruction of ischemic contracture in the lower limb. Chin J Traumatol. 2011 Apr 1. 14(2):96-9. [Medline].

  24. Hashimoto K, Kuniyoshi K, Suzuki T, Hiwatari R, Matsuura Y, Takahashi K. Biomechanical Study of the Digital Flexor Tendon Sliding Lengthening Technique. J Hand Surg Am. 2015 Aug 22. [Medline].

  25. Fischer JP, Elliott RM, Kozin SH, Levin LS. Free function muscle transfers for upper extremity reconstruction: a review of indications, techniques, and outcomes. J Hand Surg Am. 2013 Dec. 38 (12):2485-90. [Medline].

  26. Fitzgerald AM, Gaston P, Wilson Y. Long-term sequelae of fasciotomy wounds. Br J Plast Surg. 2000 Dec. 53(8):690-3. [Medline].

  27. Ultee J, Hovius SE. Functional results after treatment of Volkmann's ischemic contracture: a long-term followup study. Clin Orthop Relat Res. 2005 Feb. 42-9. [Medline].

Volkmann contracture. Supracondylar fracture.
Volkmann contracture. Supracondylar fracture.
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