Complications

• Muscle and soft tissue necrosis with a higher risk of infection

• Nerve lesions (esp. the tibial nerve and peroneal nerve) with sensory and motor deficits or paralysis

• Rhabdomyolysis with potential crush syndrome

• Malunion fractures

• Definition: permanent shortening of the forearm muscles resulting in a claw-like deformity of the fingers, hand, and wrist

• Etiology

  • Undiagnosed compartment syndrome (especially due to tight casts/bandages and crush injuries)

  • Supracondylar humeral fracture

• Pathophysiology: blood vessel (e.g., brachial artery) or nerve (e.g., radial nerve) damage (e.g., due to forearm fracture, repositioning of the bones, restrictive cast) → sustained ischemia and necrosis → fibrosis and contracture of the forearm flexor muscles → atrophy of the flexors of the hand and fingers

• Clinical features

  • Thumb adduction

  • Flexed fingers and wrist

  • Pain on passive extension of affected fingers and wrist

  • Elbow flexion and forearm pronation

  • Decreased sensation

  • Intrinsic minus deformation (advanced cases): overextended metacarpophalangeal joints and flexed interphalangeal joint

• Diagnostics: clinical diagnosis

• Differential diagnosis: Dupuytren contracture

• Treatment

  • Conservative: physical therapy, dynamic elbow splint

  • Surgical: tendon transfer procedures, nerve decompression (severely impaired hand function)

• Rebound compartment syndrome

  • Onset: occurs 6–12 hours after surgical reperfusion

  • Etiology: increased capillary permeability and edema, often due to insufficient fasciotomy incisions

The prognosis depends on the amount of time that has elapsed prior to performing the fasciotomy:

• ≤ 4–6 h: almost complete recovery

• 6–12 h: first necroses

• ≥ 12 h: necroses; little or no return of function