Clinical characteristics and treatment analysis of three cases of congenital ulnar collateral flexor contracture of the forearm_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Yu ^1,2 , XU Qian ^1,2 , MAO Haijun ^1,2 , WANG Shujuan ^1,2 , SHENG Xiaojuan ^1,2 ,  XU Guangyue ^1,2

1. Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing Jiangsu, 210008, P. R. China;
2. Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing Jiangsu, 210008, P. R. China;

Corresponding author：

XU Guangyue, Email: 15366066188@163.com

Keywords：

Congenital ulnar collateral flexor contracture of the forearm; diagnose; treatment

DOI：

10.7507/1002-1892.202309086

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Objective To report the clinical characteristics and treatment analysis of 3 cases of congenital ulnar collateral flexor contracture of the forearm and take a reference for clinic. Methods A total of 3 patients with congenital ulnar collateral flexor contracture of the forearm were admitted between February 2019 and August 2021. Two patients were male and 1 was female, and their ages were 16, 20, and 16 years, respectively. The disease durations were 8, 20, and 15 years, respectively. They all presented with flexion deformity of the proximal and distal interphalangeal joints of the middle, ring, and little fingers in the neutral or extended wrist position, and the deformity worsened in the extended wrist position. The total action motion (TAM) scores of 3 patients were 1 and the gradings were poor. The Carroll’s hand function evaluation scores were 48, 55, and 57, and the grip strength indexes were 72.8, 78.4, and 30.5. Preoperative CT of case 2 showed a bony protrusion of the flexor digitorum profundus tendon at the proximal end of the ulna; and MRI of case 3 showed that the ulnar flexor digitorum profundus presented as a uniform cord. After diagnosis, all patients were treated with operation to release the denatured tendon, and functional exercise was started early after operation. Results The incisions of 3 patients healed by first intention. Three patients were followed up for 12, 35, and 12 months, respectively. The hand function and the movement range of the joints significantly improved, but the grip strength did not significantly improve. At last follow-up, TAM scores were 3, 4, and 4, respectively, among which 2 cases were excellent and 1 case was good. Carroll’s hand function evaluation scores were 95, 90, and 94, and the grip strength indexes were 73.5, 81.3, and 34.2, respectively. Conclusion Congenital ulnar collateral flexor contracture is a rare clinical disease that should be distinguished from ischemic muscle contracture. The location of the contracture should be identified and appropriate surgical timing should be selected for surgical release. Active postoperative rehabilitation and functional exercise can achieve good hand function.

Citation： ZHANG Yu, XU Qian, MAO Haijun, WANG Shujuan, SHENG Xiaojuan, XU Guangyue. Clinical characteristics and treatment analysis of three cases of congenital ulnar collateral flexor contracture of the forearm. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(1): 51-55. doi: 10.7507/1002-1892.202309086 Copy

1.	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.
2.	张沈煜, 周俊明. 家院配合治疗儿童前臂缺血性肌挛缩. 中华手外科杂志, 2020, 36(2): 154-155.
3.	曾裴, 杨建平. 儿童前臂筋膜室间隔综合征不同时期治疗结果比较. 中华手外科杂志, 2012, 28(5): 294-296.
4.	Deeney VF, Kaye JJ, Geary SP, et al. Pseudo-Volkmann’s contracture due to tethering of flexor digitorum profundus to fractures of the ulna in children. J Pediatr Orthop, 1998, 18(4): 437-440.
5.	党洪胜, 张世琼, 王平年, 等. 指深屈肌腱粘连致假性缺血性肌挛缩的临床分析. 中华手外科杂志, 2005, 21(3): 156-157.
6.	Okazaki M, Tazaki K, Nakamura T, et al. Tendon entrapment in distal radius fractures. J Hand Surg (Eur Vol), 2009, 34(4): 479-482.
7.	Brogan K, Nicol S. Flexor digitorum profundus entrapment in paediatric forearm fractures. J Surg Case Rep, 2014(5): rju038.
8.	Song DJ, Kennebrew GJ Jr, Jex JW. Isolated ring finger flexor digitorum profundus entrapment after closed reduction and intramedullary fixation of both-bone forearm fracture. Orthopedics, 2012, 35(8): e1283-e1285.
9.	李炳万, 李大村, 李中檀. 前臂屈肌群起点下移治疗前臂缺血性肌挛缩. 中华手外科杂志, 1996, 12(2): 86-88.
10.	张秀芳, 张明, 周敬杰, 等. 虚拟情景反馈训练对Ⅱ区指屈肌腱损伤修复术后患者手功能恢复的影响. 中华物理医学与康复杂志, 2017, 39(8): 614-617.
11.	朱婵, 易南, 石梦娜, 等. 功能训练联合自制手屈曲训练带治疗手背部烧伤后瘢痕挛缩的效果观察. 中华烧伤杂志, 2017, 33(7): 426-430.
12.	Xiong G, Ren H, Zhang Y. Congenital flexion deformity with an aberrant origin of the flexor digitorum profundus: a potentially ignored disease. J Hand Surg (Am), 2015, 40(10): 2117-2118.
13.	Xiong G, Gao YB, 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.
14.	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.
15.	Xiong G, Sun Y, Wang S. Congenital flexion deformity of the long, ring, and little fingers with an aberrant origin of the flexor digitorum profundus: case report. J Hand Surg (Am), 2008, 33(8): 1358-1361.

1. 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.
2. 张沈煜, 周俊明. 家院配合治疗儿童前臂缺血性肌挛缩. 中华手外科杂志, 2020, 36(2): 154-155.
3. 曾裴, 杨建平. 儿童前臂筋膜室间隔综合征不同时期治疗结果比较. 中华手外科杂志, 2012, 28(5): 294-296.
4. Deeney VF, Kaye JJ, Geary SP, et al. Pseudo-Volkmann’s contracture due to tethering of flexor digitorum profundus to fractures of the ulna in children. J Pediatr Orthop, 1998, 18(4): 437-440.
5. 党洪胜, 张世琼, 王平年, 等. 指深屈肌腱粘连致假性缺血性肌挛缩的临床分析. 中华手外科杂志, 2005, 21(3): 156-157.
6. Okazaki M, Tazaki K, Nakamura T, et al. Tendon entrapment in distal radius fractures. J Hand Surg (Eur Vol), 2009, 34(4): 479-482.
7. Brogan K, Nicol S. Flexor digitorum profundus entrapment in paediatric forearm fractures. J Surg Case Rep, 2014(5): rju038.
8. Song DJ, Kennebrew GJ Jr, Jex JW. Isolated ring finger flexor digitorum profundus entrapment after closed reduction and intramedullary fixation of both-bone forearm fracture. Orthopedics, 2012, 35(8): e1283-e1285.
9. 李炳万, 李大村, 李中檀. 前臂屈肌群起点下移治疗前臂缺血性肌挛缩. 中华手外科杂志, 1996, 12(2): 86-88.
10. 张秀芳, 张明, 周敬杰, 等. 虚拟情景反馈训练对Ⅱ区指屈肌腱损伤修复术后患者手功能恢复的影响. 中华物理医学与康复杂志, 2017, 39(8): 614-617.
11. 朱婵, 易南, 石梦娜, 等. 功能训练联合自制手屈曲训练带治疗手背部烧伤后瘢痕挛缩的效果观察. 中华烧伤杂志, 2017, 33(7): 426-430.
12. Xiong G, Ren H, Zhang Y. Congenital flexion deformity with an aberrant origin of the flexor digitorum profundus: a potentially ignored disease. J Hand Surg (Am), 2015, 40(10): 2117-2118.
13. Xiong G, Gao YB, 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.
14. 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.
15. Xiong G, Sun Y, Wang S. Congenital flexion deformity of the long, ring, and little fingers with an aberrant origin of the flexor digitorum profundus: case report. J Hand Surg (Am), 2008, 33(8): 1358-1361.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical characteristics and treatment analysis of three cases of congenital ulnar collateral flexor contracture of the forearm

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