Seddon, J Bone Joint Surg Br 1966 - Volkmann's Ischaemia in the Lower Limb

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Volkmann's Ischaemia in the Lower Limb

Seddon·J Bone Joint Surg Br·1966·89 citations·Case series

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Seddon examined which injuries cause Volkmann's ischaemia in the lower limb, which tissues it damages, and how it can be prevented and treated. Case series of 15 patients with lower limb Volkmann's ischaemia, excluding the anterior tibial syndrome, with Ellis's Sheffield tibial fracture data for incidence.

Key Findings

Flexor hallucis longus was the most frequently damaged muscle where the affected muscles could be identified. Gastrocnemius was often spared. No other consistent pattern of muscle involvement was found.
Ischaemic nerve damage occurred in 12 of 14 patients:
- Peroneal and tibial nerves: 7
- Tibial nerve alone: 3
- Peroneal nerve alone: 2
Pain occurred in 6 of 15 cases, a feature Seddon had not seen in upper limb ischaemia. In one patient pain alone led to amputation.
Amputation was needed in 27% (4/15) for pain, ulceration, scarring or intractable deformity, with satisfactory results afterwards.
Significance: Seddon described lower limb Volkmann's ischaemia as distinct from the forearm form, lacking its predictable infarct pattern, with ischaemic nerve injury and pain as features and amputation as an acceptable outcome.

Board PearlIn lower limb Volkmann's ischaemia, flexor hallucis longus was the most frequently damaged muscle while gastrocnemius was often spared.

Volkmann's Ischaemia in the Lower Limb.

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Volkmann's Ischaemia in the Lower Limb

Seddon·J Bone Joint Surg Br·1966·89 citations·Case series

|

Seddon examined which injuries cause Volkmann's ischaemia in the lower limb, which tissues it damages, and how it can be prevented and treated. Case series of 15 patients with lower limb Volkmann's ischaemia, excluding the anterior tibial syndrome, with Ellis's Sheffield tibial fracture data for incidence.

Key Findings

Flexor hallucis longus was the most frequently damaged muscle where the affected muscles could be identified. Gastrocnemius was often spared. No other consistent pattern of muscle involvement was found.
Ischaemic nerve damage occurred in 12 of 14 patients:
- Peroneal and tibial nerves: 7
- Tibial nerve alone: 3
- Peroneal nerve alone: 2
Pain occurred in 6 of 15 cases, a feature Seddon had not seen in upper limb ischaemia. In one patient pain alone led to amputation.
Amputation was needed in 27% (4/15) for pain, ulceration, scarring or intractable deformity, with satisfactory results afterwards.
Significance: Seddon described lower limb Volkmann's ischaemia as distinct from the forearm form, lacking its predictable infarct pattern, with ischaemic nerve injury and pain as features and amputation as an acceptable outcome.

Board PearlIn lower limb Volkmann's ischaemia, flexor hallucis longus was the most frequently damaged muscle while gastrocnemius was often spared.

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