Volkmann Ischemic Contracture Due to Traditional Practice Hind Mahmood 1 , Abdulzahra Hussain 1,2 Abstract An 11-year-old boy presented with three days’ history of blunt trauma to the left shoulder due to a fall to the ground. The boy was taken to the traditional practi- tioner, who applied a very tight bandage over a piece of cartoon on the upper left humerus, which resulted in progressive pain and swelling of the whole left upper limb and impairment of movement and sensation. The tight bandage was removed after 48 h and fasciotomy was performed at Aljamhuri Hospital in Taiz, Yemen. The child was brought to our hospital after the family was informed about the need for left forearm ampu- tation. We performed four sessions of debridement of the dead muscles and soft tissues of the flexor and extensor compartments of the left upper limb. After three months, the left upper limb healed with fixed flexor contracture of the elbow and wrist joint. Manipulation and release of adhesions and subsequent skin grafting was performed and the elbow joint was kept in extension, the wrist in the neutral position, and the interphalangeal joints in flexion. Although the limb was saved, its aesthetic appearance was retained, and some sensation was achieved, the lost motor function of the forearm (including the hand) was irreversible. Key Words Compartment syndrome Æ Volkmann ischemic contracture Æ Fasciotomy Æ Debridement Æ C-reacting protein Eur J Trauma Emerg Surg 2008 DOI 10.1007/s00068-008-8086-9 Introduction Compartment syndrome (CS) results from increased pressure within a specific anatomical region. It can affect any part of the body, including the abdomen and extremities, and may lead to organ failure [1]. Different causes of it and methods of diagnosis have been iden- tified, and the great advantage of prevention is well documented and highlighted in the literature. Cur- rently, the most effective treatment for established compartment syndrome is surgical decompression [2]. One serious consequence of CS affecting extremities is Volkmann ischemic contracture (VIC). This may be congenital or acquired due to trauma or the application of a tight tourniquet, splint or cast around the affected limb [3]. Supracondylar humerus fracture is associated with CS; about 8% of these severely displaced fractures are characterized by vascular complications, and urgent anatomical reduction is needed to avoid CS [4]. VIC is a rare problem in developed countries due to the pres- ence of an advanced health infrastructure and preven- tion facilities based on early detection and treatment of the underlying cause. However, the picture is different in developing nations, where VIC can still result in loss of limb function due to completely avoidable pathol- ogy. The strategy for managing CS and its consequences (VIC) has seen significant progression in recent years. Different approaches have been shown to be effective and approved for CS treatment. In this work, we report a case in which we were involved in part of the management. The aim is to show the impact of the poor knowledge of traditional practitioners, especially in rural areas of Yemen. We also discuss what can be done to treat an established Volkmann ischemic contracture. Case Report An 11-year-old boy sustained a blunt trauma to the left shoulder by falling to the ground in a village near Taiz, Yemen. Because of traditional beliefs, the family 1 General Surgery Department, Alburaihy Hospital, Taiz, Yemen, 2 General Surgery Department, Princess Royal University Hospital, Farnborough Common, Kent, UK. Received: June 1, 2008; revision accepted: September 23, 2008; Published Online: November 3, 2008 European Journal of Trauma and Emergency Surgery Case Report Eur J Trauma Emerg Surg 2008 Ó URBAN &VOGEL