Flexor digitorum profundus entrapment in paediatric forearm fractures

Entrapment of the flexor digitorum profundus (FDP) is a recognized complication of paediatric both-bone forearm fractures. Although a rare complication, it is usually missed at the time of initial fracture management resulting in the need for corrective surgery. An attempted closed manipulation followed by immediate surgical correction of FDP entrapment in our hospital prompted a review of the evidence on this underreported problem. A comprehensive English language literature search was performed using Embase, Medline and Pubmed. Twenty cases have been reported in the literature and all were diagnosed post-operatively (range 2 days-16 years). Eighteen cases (90%) required surgical correction. Five cases (25%) were initially diagnosed as mild Volkmann's contracture yet at surgery no case was found to have evidence of previous muscle ischaemia. Although subclinical or mild Volkmann's ischaemic contracture is a recognized complication of closed forearm fracture, this report highlights the importance of considering a diagnosis of muscle entrapment in cases of flexion contracture.