SN6 SHORT NOTE 5M

Describe Contractures in detail.

General Surgery · Final Professional

Definition

A contracture is a fixed limitation of the range of movement of a joint due to shortening or fibrosis of the soft tissues around it (skin, muscle, tendon, capsule/ligament) or to changes within the joint. It results in the joint being held in a fixed position that cannot be fully corrected passively.

Types & Causes

Contractures are classified by the tissue responsible: dermatogenic (skin — e.g. Burn scars), myogenic (muscle — e.g. Volkmann’s ischaemic contracture, spastic cerebral palsy), arthrogenic (the joint itself — e.g. Infection, arthritis), and those due to tendon/fascia (Dupuytren’s). Common underlying causes are immobilisation, muscle imbalance/spasticity, ischaemia, burns, and joint disease.

CLINICAL PEARL

Most contractures are far easier to prevent than to correct: correct positioning, regular passive movement and splinting of at-risk joints (in the paralysed, burned or immobilised patient) avoid the fixed deformity that later needs surgery.

Management

Prevention is central — physiotherapy (passive stretching, maintaining range), correct positioning and splinting of vulnerable joints. Established contractures are treated by physiotherapy and serial splinting/casting for milder cases, and surgical release (soft-tissue release/lengthening, capsulotomy, skin grafting/Z-plasty for skin contractures) for fixed deformity, followed by therapy to maintain the correction.

Clinical Note

A useful way to remember the classification is by the tissue that has shortened — skin, muscle, joint or tendon/fascia — because it points directly to the treatment (skin grafting or Z-plasty for a burn contracture, muscle release or slide for an ischaemic or spastic one, capsulotomy for an arthrogenic one). Above all, the at-risk joint in a paralysed, burned or immobilised patient should be kept moving and correctly positioned from the outset, since a prevented contracture needs no surgery.

CLINICAL PEARL

Name the contracture by the tissue that has shortened — skin, muscle, joint or fascia — because that points straight to the remedy; and above all keep at-risk joints moving and correctly positioned, since a contracture prevented needs no surgery.

Prevention by positioning and physiotherapy is far easier than correction.

KEY POINT

Key points TO remember

Fixed limitation of joint movement from soft-tissue shortening/fibrosis or joint change.
Types: dermatogenic (skin/burns), myogenic (Volkmann’s, spasticity), arthrogenic, tendon/fascia (Dupuytren’s).
Common causes: immobilisation, spasticity, ischaemia, burns, joint disease.
Prevention (positioning, movement, splints) is key; release surgery + therapy for fixed deformity.

EXAM TIP

Sources: Maheshwari's Essential Orthopaedics; Apley & Solomon's System of Orthopaedics and Trauma; AO Principles of Fracture Management.

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