Late Flexor Entrapment in Neocortex After Pediatric Forearm Fracture: A Case Report.

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Trauma surgery

Background:

• Monteggia-equivalent fractures are complex injuries in pediatric patients.
• Acute flexor tendon entrapment is a known complication of forearm fractures.
• Late-onset complications require careful consideration for long-term patient outcomes.

Observation:

• A pediatric patient with an open Monteggia-equivalent fracture developed late-onset extrinsic flexor tightness of the index finger.
• A neocortex formed around the torn ulnar periosteum, entrapping the index flexor digitorum profundus (FDP) muscle.
• The patient presented 5 years after the initial injury with restricted finger motion.

Findings:

• The entrapped FDP muscle belly within the neocortex was identified as the cause of the finger stiffness.
• Surgical release of the entrapped FDP muscle was performed.
• Significant improvement in index finger motion was achieved after the proximal muscle release procedure.

Implications:

• This case highlights a rare cause of late-onset flexor tendon entrapment following pediatric forearm fractures.
• It emphasizes the importance of considering unusual soft tissue complications even years after initial injury.
• Prompt diagnosis and surgical intervention, even for long-standing contractures, can lead to functional recovery in pediatric orthopedic trauma.