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Entrapment of the flexor digitorum profundus following paediatric forearm fractures
Michael L Fernandez1, Lee S Segal
1Department of Orthopaedics and Rehabilitation, Pennsylvania State University College of Medicine, Penn State Hershey Medical Center Hershey, Pennsylvania 17033, USA.
Insights
Paediatric forearm fractures can lead to finger contractures. Early identification of specific fracture patterns and ulnar defects is crucial for timely treatment of these rare complications.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Hand Surgery
Background:
- Established complications of pediatric both-bone forearm fractures include malunion, refracture, and neurovascular injury.
- Less common complications require further investigation for improved patient outcomes.
Observation:
- Two cases of pediatric patients developed small and ring finger flexion contractures after treatment for both-bone forearm fractures.
- Both closed and operative treatments were associated with these contractures.
Findings:
- Exploration revealed tethering of the flexor digitorum profundus and fibrotic scar tissue at the ulna fracture site.
- Key indicators include a characteristic injury pattern, persistent ulnar cortical defects post-healing, and delayed contracture identification after cast removal.
Implications:
- Recognizing these specific features aids in the diagnosis and management of flexion contractures following pediatric forearm fractures.
- This highlights the importance of thorough evaluation for less common complications in pediatric fracture care.
Abstract:
The complications of closed and open reduction of paediatric both-bone forearm fractures have been well established. These include malunion, refracture, neurovascular insult, compartment syndrome, infection, and soft tissue/nerve entrapment. We describe two cases of small and ring finger flexion contractures as a complication of closed and operative treatment of healed paediatric both-bone forearm fractures. In both instances, tethering of the flexor digitorum profundus and fibrotic scar tissue interposed at the ulna fracture site was noted at the time of exploration. Evidence of a characteristic fracture pattern at the time of injury, persistent ulnar cortical defect after fracture healing, and delayed identification of the contractures following cast removal are key features in identifying and treating these complications.
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