Traditional Bonesetter-Induced Volkmann Contracture Treated by Staged Reconstructive Surgery

Objectives: Volkmann ischemic contracture is a rare but serious complication resulting from untreated compartment syndrome, typically manifesting as irreversible muscle fibrosis and joint deformities. This case is noteworthy due to its delayed presentation and successful surgical management in a resource-limited setting where traditional bonesetter practices remain prevalent. Case presentation: A 16-year-old Afghan male of Tajik ethnicity from Ghor province presented with a severe deformity of the right forearm, characterized by persistent flexion, forearm pronation, thumb adduction, and significant muscle atrophy. The condition developed following a childhood forearm fracture managed by a traditional bonesetter, leading to chronic ischemia and progressive dysfunction. Clinical and imaging evaluations confirmed a moderate form of Volkmann ischemic contracture. The patient underwent staged reconstructive surgery, which included tendon lysis, muscle fractional lengthening, flexor muscle origin sliding, and carpal tunnel release. The limb was immobilized postoperatively, followed by a structured rehabilitation program. At 18 months follow-up, the patient demonstrated marked improvement in functional mobility and grip strength, with a notable reduction in the Disability of Arm, Shoulder and Hand (DASH) score from 38.6% to 6.8%. Conclusion: This case underscores the importance of early recognition and timely intervention in compartment syndrome to prevent Volkmann ischemic contracture. Furthermore, it illustrates that even in cases of long-standing contractures, multistage surgical reconstruction can yield substantial functional recovery. Public health efforts to educate communities on the risks associated with traditional bone-setting.