Pathogenesis of Volkmann's ischemic contracture of the first web space and treatment.

Reporting three cases of sequelae of Volkmann's ischemia of the first web space of the hand, following barbiturate overdose, the authors suggest several pathogenic hypothesis. The major factor is obviously an elective compression of the top of the first commissure on its dorsal aspect but it due to a compartmental syndrome or to a stoppage in the blood flow? The second explanation seems the best; the radial artery compressed at the top of the first commissure over the first dorsal intermetacarpal ligament is not able to vascularize the dorsal digital artery of the thumb and the first dorsal interosseous artery. These arteries being terminal in type, an elective muscle necrosis is takes place in the adductor pollicis and the first dorsal interosseous. This phenomenon being increased in this last muscle by a simultaneous compartmental syndrome. A precocious diagnosis must be made during the acute stage and some logical surgical procedures performed in emergency: fasciectomy, muscle excision and fixation of the trapezometacarpal joint in opposition with a pin.