Surgery MCQs Q49

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ORTHOPEDICS • PEDIATRIC TRAUMA

A patient develops severe pain, pallor, and paresthesia distal to a limb injury after application of a tight cast. There is concern for evolving compartment syndrome leading to Volkmann’s ischemic contracture.

Which of the following injuries is most classically associated with Volkmann’s ischemic contracture?

A Intertrochanteric femoral fracture

B Posterior dislocation of knee

C Supracondylar fracture of humerus

D Traumatic shoulder separation

E Colles’ fracture

The correct answer is Supracondylar fracture of humerus.

Decoding the Stem

1

CLUE "Volkmann’s ischemic contracture"

TRANSLATION Compartment syndrome of forearm flexors → usually after elbow injury in children.

Detailed Explanation

✅ Correct Option (Supracondylar Humerus Fracture): This is the injury most classically associated with Volkmann’s ischemic contracture. In children, a displaced supracondylar fracture can cause either direct brachial artery injury or severe swelling, leading to forearm compartment syndrome.

The Pathological Sequence:

→ Mechanism: Fracture/Injury → Brachial artery compression/spasm → Ischemia of flexor muscles (deep flexors like FDP/FPL affected first).

→ Late Result: Necrotic muscle is replaced by fibrous tissue → Fibrosis causes shortening (contracture).

→ Classic Deformity: Wrist flexion + MCP extension + IP flexion (Claw-like hand).

❌ Why other options are incorrect:

→ Intertrochanteric Femoral Fracture: Affects the hip/thigh region. Does not relate to forearm syndromes.

→ Posterior Knee Dislocation: Can cause popliteal artery injury and leg compartment syndrome, but is not the classic association for "Volkmann's."

→ Colles' Fracture: Distal radius fracture in adults; may cause Median Nerve compression (CTS), but rarely compartment syndrome resulting in Volkmann's.

🧠 High-Yield Pearls

✔ Most common cause: Supracondylar fracture (pediatric).

✔ Early Warning: Pain out of proportion to injury (especially on passive extension).

✔ Late Sign: Paralysis and loss of pulse (indicates irreversible damage).

Integrated Clinical Questions

1. Most important early symptom?

→ Pain out of proportion (especially during passive extension of fingers).

2. Most affected muscle group?

→ Deep Forearm flexors (Flexor Digitorum Profundus and Flexor Pollicis Longus).

3. Key artery involved?

→ Brachial artery.

4. Definitive emergency treatment?

→ Emergency fasciotomy to release compartment pressure.

5. Classic deformity called?

→ Claw-like hand / Volkmann contracture.

⚡ Exam Pearls

• • Supracondylar fracture = pediatric emergency.
• • Always think: Compartment syndrome → Volkmann contracture.
• • Early recognition is critical: Pain > pulse loss (important exam concept).

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