Seddon reviews 15 cases of Volkmann's ischaemia in the lower limb to define which injuries cause it, which tissues are affected, and how to prevent and treat it. The anterior tibial syndrome is explicitly excluded. This is the first systematic characterisation of the condition as a distinct entity from its upper limb counterpart.
Volkmann's ischaemia was widely regarded as a problem of the upper limb — Seddon's own forearm infarct model had shaped how surgeons thought about the condition. This paper forced a rethink: the leg behaves differently, affects adults rather than children, and cannot be managed with the same anatomical framework.
When you have a tibial fracture or knee dislocation with any sign of impending ischaemia, fasciotomy of the anterior and lateral compartments is the first move. Not watchful waiting. Ellis's data shows 2.6% of tibial fractures harbour unrecognised ischaemia, so the threshold for intervention must be low.
If your patient develops lower limb Volkmann's contracture with pain, do not assume the nerve injury is compressive and amenable to neurolysis. The damage is ischaemic in origin. Posterior tibial nerve grafting has no role. Counsel patients that pain may persist, and that amputation. With its satisfactory functional results in Seddon's series. Is a legitimate endpoint rather than a last resort.
The flexor hallucis longus is your clinical canary: it is the most consistently affected muscle and its contracture drives the characteristic equinovarus deformity. Excise necrotic muscle belly, not just the tendon. Leaving destroyed muscle guarantees contracture recurrence.
Seddon reviews 15 cases of Volkmann's ischaemia in the lower limb to define which injuries cause it, which tissues are affected, and how to prevent and treat it. The anterior tibial syndrome is explicitly excluded. This is the first systematic characterisation of the condition as a distinct entity from its upper limb counterpart.
Volkmann's ischaemia was widely regarded as a problem of the upper limb — Seddon's own forearm infarct model had shaped how surgeons thought about the condition. This paper forced a rethink: the leg behaves differently, affects adults rather than children, and cannot be managed with the same anatomical framework.
When you have a tibial fracture or knee dislocation with any sign of impending ischaemia, fasciotomy of the anterior and lateral compartments is the first move. Not watchful waiting. Ellis's data shows 2.6% of tibial fractures harbour unrecognised ischaemia, so the threshold for intervention must be low.
If your patient develops lower limb Volkmann's contracture with pain, do not assume the nerve injury is compressive and amenable to neurolysis. The damage is ischaemic in origin. Posterior tibial nerve grafting has no role. Counsel patients that pain may persist, and that amputation. With its satisfactory functional results in Seddon's series. Is a legitimate endpoint rather than a last resort.
The flexor hallucis longus is your clinical canary: it is the most consistently affected muscle and its contracture drives the characteristic equinovarus deformity. Excise necrotic muscle belly, not just the tendon. Leaving destroyed muscle guarantees contracture recurrence.