COVID-19 as a Contributing Factor in the Development of Volkmann Ischemic Contracture: A Case Report

Volkmann ischemic contracture (VIC) is a rare but devastating complication of untreated acute compartment syndrome, typically resulting in irreversible flexion deformities due to ischemic necrosis. While its pathophysiology is well understood, evolving clinical contexts, such as COVID-19, may present novel challenges in the early recognition and management of the condition. We describe the case of a 55-year-old man who developed fixed flexion deformity involving the forearm flexor muscles following a misdiagnosis of compartment syndrome during COVID-19 isolation. Symptoms were initially attributed to cellulitis, and multiple superficial incisions were performed for presumed abscess drainage without confirmation of purulence or infection. Delayed intervention led to muscle necrosis and subsequent contracture. Upon tertiary referral, a diagnosis of VIC was established based on clinical findings. Surgical decompression, debridement, and neurolysis were performed, resulting in partial functional recovery. This case highlights the importance of recognizing compartment syndrome, even in the absence of trauma, and raises the possibility that COVID-19 may contribute to the pathophysiology of VIC. We discuss mechanisms that include cytokine-mediated edema, endothelial dysfunction, diagnostic delay, and impaired wound healing.