Acute Both Bone Fracture in a Chronic Contracted Forearm

Area of Science:

• Orthopedic surgery
• Trauma management
• Upper extremity reconstruction

Background:

• Volkmann's contracture, often resulting from compartment syndrome, presents unique challenges in managing concurrent forearm fractures.
• Delayed presentation due to substance abuse can exacerbate these complex orthopedic injuries.
• Limited literature exists on the surgical management of forearm fractures in the presence of pre-existing ischemic contractures.

Observation:

• A 39-year-old female with a chronic Volkmann's contracture sustained a severely displaced both bone (BB) forearm fracture.
• Despite functional limitations, the affected limb was crucial for daily activities.
• The patient's history included substance abuse, contributing to delayed presentation.

Findings:

• Surgical management involved open reduction internal fixation with radial and ulnar shortening osteotomies.
• The procedure aimed to restore cortical alignment despite significant soft tissue contractures.
• Fracture union was prioritized over strict adherence to standard open reduction and internal fixation principles due to the limb's pre-existing condition.

Implications:

• Management of BB fractures in contracted forearms may necessitate a shift in focus from anatomical restoration to achieving fracture union.
• The fibrotic soft tissue envelope in Volkmann's contracture can impede normal fracture healing.
• Close postoperative monitoring of both osseous and soft tissue healing is crucial for successful outcomes in these complex cases.