Diagnosis and treatment of finger flexion contracture caused by forearm flexor disease_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Peng ¹ ,  WEI Jianwei ¹ , DONG Zhonggen ¹ , LIU Lihong ¹ , SHEN Ao ¹ , WANG Jianhua ²

1. Department of Orthopedics, the Second Xiangya Hospital of Central South University, Changsha Hunan, 410011, P. R. China;
2. Department of Bone Microsurgery, Sanya People’s Hospital, Sanya Hainan, 572000, P. R. China;

Corresponding author：

WEI Jianwei, Email: doctorway@csu.edu.cn

Keywords：

Volkmann’s contracture; pseudo-Volkmann’s contracture; flexion contracture; finger; forearm

DOI：

10.7507/1002-1892.202211065

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Objective To summarize the clinical characteristics, differential diagnosis, and treatment methods of finger flexion contracture caused by three kinds of forearm flexor diseases. Methods Between December 2008 and August 2021, 17 patients with finger flexion contracture were treated, including 8 males and 9 females, aged 5-42 years, with a median of 16 years. The disease duration ranged from 1.5 months to 30 years, with a median of 13 years. The etiology included 6 cases of Volkmann’s contracture, all of which were flexion deformity of the 2nd to 5th fingers, accompanied by limitation of thumb dorsiflexion in 3 cases and limitation of wrist dorsiflexion in 3 cases; 3 cases of pseudo-Volkmann’s contracture, including 2 cases of flexion deformity of middle, ring, and little fingers, and 1 case of flexion deformity of ring and little fingers; 8 cases of ulnar finger flexion contracture caused by forearm flexor disease or anatomical variations, all of which were flexion deformity of middle, ring, and little fingers. Operations such as slide of flexor and pronator teres origin, excision of abnormal fibrous cord and bony prominence, and release of entrapped muscle (tendon) were performed. Hand function was evaluated according to WANG Haihua’s hand function rating standard or modified Buck-Gramcko classification standard, and muscle strength was evaluated according to British Medical Research Council (MRC) muscle strength rating standard. Results All patients were followed up 1-10 years (median, 1.5 years). At last follow-up, 8 patients with contracture caused by forearm flexor disease or anatomical variations and 3 patients with pseudo-Volkmann’s contracture achieved excellent hand function, with muscle strength of grade M5 in 6 cases and grade M4 in 5 cases. One patient with mild Volkmann’s contracture and 3 patients with moderate Volkmann’s contracture without severe nerve damage had excellent hand function in 2 cases and good in 2 cases, with muscle strength of grade M5 in 1 case and grade M4 in 3 cases. Two patients with moderate or severe Volkmann’s contracture had poor hand function, with 1 case of muscle strength of grade M3 and 1 case of grade M2, which improved when compared with those before operation. The overall excellent and good rate of hand function and the proportion of patients with muscle strength of grade M4 and above were 88.2% (15/17), respectively. Conclusion The finger flexion contracture caused by different etiology can be differentiated by analyzing the history, physical examination, radiographs, and intraoperative findings. After different surgical treatments, such as resection of contracture band, release of compressed muscle (tendon), and downward movement of flexor origin, most patients have a good outcome.

Citation： TANG Peng, WEI Jianwei, DONG Zhonggen, LIU Lihong, SHEN Ao, WANG Jianhua. Diagnosis and treatment of finger flexion contracture caused by forearm flexor disease. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(4): 447-451. doi: 10.7507/1002-1892.202211065 Copy

1.	Neri I, Magnano M, Pini A, et al. Congenital Volkmann syndrome and aplasia cutis of the forearm: a challenging differential diagnosis. JAMA Dermatol, 2014, 150(9): 978-980.
2.	Geissler J, Westberg J, Stevanovic M. Pseudo-volkmann contracture: A case report and review of the current literature. J Am Acad Orthop Surg Glob Res Rev, 2018, 2(11): e031. doi: 10.5435/JAAOSGlobal-D-18-00031.
3.	王海华, 张友乐, 张春林, 等. 单纯性前臂屈肌挛缩的诊断与治疗. 中华手外科杂志, 2008, 24(6): 340-342.
4.	Xiong G, Yongbin Gao None, Zhu J, et al. Congenital contracture of the ulnar digits and its differentiation from ischemic contracture. J Hand Surg (Am), 2022, 47(6): 579.e1-579.e9.
5.	Ultee J, Hovius SE. Functional results after treatment of Volkmann’s ischemic contracture: a long-term followup study. Clin Orthop Relat Res, 2005, (431): 42-49.
6.	Reigstad A, Hellum C. Volkmann’s ischaemic contracture of the forearm. Injury, 1980, 12(2): 148-150.
7.	Schnall SB, Holtom PD, Silva E. Compartment syndrome associated with infection of the upper extremity. Clin Orthop Relat Res, 1994, (306): 128-131.
8.	王乐, 方有生, 徐秀玥, 等. 儿童前臂缺血性肌挛缩的手术疗效分析. 中华手外科杂志, 2022, 38(3): 190-191.
9.	Sabapathy SR, Venkatramani H, Bhardwaj P, et al. Technical considerations and outcome of free functioning gracilis muscle transfer for finger flexion in patients with Volkmann’s Ischemic Contracture. Injury, 2021, 52(12): 3640-3645.
10.	Ozer K. Nerve lesions in Volkmann ischemic contracture. J Hand Surg (Am), 2020, 45(8): 746-757.
11.	Rayan GM, Hayea M. Entrapment of the flexor digitorum profundus in the ulna with fracture of both bones of the forearm. Report of a case. J Bone Joint Surg (Am), 1986, 68(7): 1102-1103.
12.	Jeffery CC. Contracture of fingers due to fixation of the flexor profundus digitorum to the ulna. Hand, 1976, 8(1): 32-35.
13.	Baudet J, Lafond P. Pseudo-Volkmann syndromes. Ann Chir Plast, 1979, 24(2): 173-181.
14.	O’Brien JP, Hodgson AR. Congenital abnormality of the flexor digitorum profundus, a cause of flexion deformity of the long and ring fingers. Clin Orthop Relat Res, 1974, (104): 206-208.
15.	Takagi T, Takayama S, Ikegami H, et al. Congenital shortening of the flexor digitorum profundus muscle. J Hand Surg (Am), 2007, 32(2): 168-171.
16.	Li H, Guan S. Progressing flexion deformity of the middle, ring, and small fingers with a rare congenital anatomic difference of flexor digitorum profundus. J Pediatr Orthop, 2020, 40(7): e603-e608.

1. Neri I, Magnano M, Pini A, et al. Congenital Volkmann syndrome and aplasia cutis of the forearm: a challenging differential diagnosis. JAMA Dermatol, 2014, 150(9): 978-980.
2. Geissler J, Westberg J, Stevanovic M. Pseudo-volkmann contracture: A case report and review of the current literature. J Am Acad Orthop Surg Glob Res Rev, 2018, 2(11): e031. doi: 10.5435/JAAOSGlobal-D-18-00031.
3. 王海华, 张友乐, 张春林, 等. 单纯性前臂屈肌挛缩的诊断与治疗. 中华手外科杂志, 2008, 24(6): 340-342.
4. Xiong G, Yongbin Gao None, Zhu J, et al. Congenital contracture of the ulnar digits and its differentiation from ischemic contracture. J Hand Surg (Am), 2022, 47(6): 579.e1-579.e9.
5. Ultee J, Hovius SE. Functional results after treatment of Volkmann’s ischemic contracture: a long-term followup study. Clin Orthop Relat Res, 2005, (431): 42-49.
6. Reigstad A, Hellum C. Volkmann’s ischaemic contracture of the forearm. Injury, 1980, 12(2): 148-150.
7. Schnall SB, Holtom PD, Silva E. Compartment syndrome associated with infection of the upper extremity. Clin Orthop Relat Res, 1994, (306): 128-131.
8. 王乐, 方有生, 徐秀玥, 等. 儿童前臂缺血性肌挛缩的手术疗效分析. 中华手外科杂志, 2022, 38(3): 190-191.
9. Sabapathy SR, Venkatramani H, Bhardwaj P, et al. Technical considerations and outcome of free functioning gracilis muscle transfer for finger flexion in patients with Volkmann’s Ischemic Contracture. Injury, 2021, 52(12): 3640-3645.
10. Ozer K. Nerve lesions in Volkmann ischemic contracture. J Hand Surg (Am), 2020, 45(8): 746-757.
11. Rayan GM, Hayea M. Entrapment of the flexor digitorum profundus in the ulna with fracture of both bones of the forearm. Report of a case. J Bone Joint Surg (Am), 1986, 68(7): 1102-1103.
12. Jeffery CC. Contracture of fingers due to fixation of the flexor profundus digitorum to the ulna. Hand, 1976, 8(1): 32-35.
13. Baudet J, Lafond P. Pseudo-Volkmann syndromes. Ann Chir Plast, 1979, 24(2): 173-181.
14. O’Brien JP, Hodgson AR. Congenital abnormality of the flexor digitorum profundus, a cause of flexion deformity of the long and ring fingers. Clin Orthop Relat Res, 1974, (104): 206-208.
15. Takagi T, Takayama S, Ikegami H, et al. Congenital shortening of the flexor digitorum profundus muscle. J Hand Surg (Am), 2007, 32(2): 168-171.
16. Li H, Guan S. Progressing flexion deformity of the middle, ring, and small fingers with a rare congenital anatomic difference of flexor digitorum profundus. J Pediatr Orthop, 2020, 40(7): e603-e608.

Chinese Journal of Reparative and Reconstructive Surgery

Diagnosis and treatment of finger flexion contracture caused by forearm flexor disease

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