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January 1970

Early Recognition and Treatment of Impending Volkmann's Ischemia in the Lower Extremity

Author Affiliations

Fort Sam Houston, Tex
From the Orthopaedic Service, Brooke General Hospital, Brooke Army Medical Center, Fort Sam Houston, Tex.

Arch Surg. 1970;100(1):11-16. doi:10.1001/archsurg.1970.01340190013005

Volkmann's ischemia in the lower extremity is a not uncommon complication of injuries or operations to the lower extremity (Fig 1). It is our intent in this discussion to point out the importance of the early recognition and treatment of impending ischemia in the lower extremity, whether it be due to a closed injury (anterior compartment syndrome) or to a severe fracture with laceration of a major vessel in the lower extremity. Our principles of treatment of impending ischemia will be emphasized, especially the prompt performance of extensive fasciotomy.

Seddon reported 15 cases of Volkmann's ischemia in the lower extremity, four of which were due to operations on the leg.1 The remainder was due to injuries, either a fracture or crushing soft tissue injuries to the lower extremity. In four of the 15 cases reported by Seddon, amputation was required. Owen and Tsimboukis reviewed 100 fractures of the tibia

Seddon, H.J.:  Volkmann's Ischaemia in the Lower Limb , J Bone Joint Surg 48:627-636 ( (Nov) ) 1966.
Owen, R., and Tsimboukis, B.:  Ischaemia Complicating Closed Tibial and Fibular Shaft Fractures , J Bone Joint Surg 49:268-275 ( (May) ) 1967.
Ellis, H.:  Disabilities After Tibial Shaft Fractures , J Bone Joint Surg 40:190-197 ( (May) ) 1958.
Thomson, S.A., and Mahoney, L.J.:  Volkmann's Ischaemic Contracture and Its Relationship to Fracture of the Femur , J Bone Joint Surg 33:336-347 ( (Aug) ) 1961.
Dehne, E., and Kirz, F.K.:  Slow Arterial Leak Consequent to Unrecognized Arterial Laceration , J Bone Joint Surg 49:372-376 ( (March) ) 1967.
Holmes, W.; Highet, W.B.; and Seddon, H.J.:  Ischaemic Nerve Lesions Occurring in Volkmann's Contracture , Brit J Surg 32:259-275 ( (Oct) ) 1944.Article