Twelve hours after a closed supracondylar humerus fracture was splinted tightly, a child reports severe increasing pain in the forearm unrelieved by analgesia. Pain is reproduced on passively extending the fingers, and there is pallor of the hand. What is the earliest and most reliable clinical sign demanding immediate release of all dressings and fasciotomy?

• A Absent radial pulse
• B Paralysis of the median nerve
• C Pain on passive stretch of the involved muscles ✓
• D Fixed claw deformity of the fingers

Explanation

In developing Volkmann's ischaemic contracture, pain on passive stretching of the affected forearm flexor muscles, together with disproportionate pain requiring escalating analgesia, is the earliest and most dependable warning sign and precedes pulse loss. Waiting for an absent radial pulse means intervention is already late, since the pulse is commonly present until late in the course. Paralysis and the fixed claw deformity represent established, irreversible muscle necrosis, eliminating options B and D.

Reference: Miller's Review of Orthopaedics, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.