Proposal of a new classification for established Volkmann's contracture

The multiple contributory aspects of the claw deformity seen in 115 cases of established Volkmann's contracture has been analyzed. This has given rise to a clinically oriented 5-Stage classification. Clinical and electrical motor nerve deficits in the median, ulnar and radial distributions have shown considerable variability between patients. The individual pattern of nerve damage has been outlined. The measurement of passive extension deficits (PED) illustrates the degree of extrinsic muscle contracture. The PED is increased proportionally to nerve damage. Secondary stigmata of chronic ischemia (ie chronic changes, sensory deficits,stiff joints, web-space and intrinsic contractures) are increased proportionally to muscle and motor nerve damage. Staging in these five groups has permitted the establishment of rapid diagnosis, severity of injury, prognostic evaluation and management modalities according to stage.