Localized type Volkmann's contracture treated with tendon transfer and tension-reduced early mobilization: A case report

Abstract

Rationale: For localized type Volkmann's contracture, in which degeneration of the flexor digitorum profundus (FDP) muscle to one or two fingers and restriction of finger extension occur, dissection or excision of the affected muscle is usually recommended. However, these surgical procedures need relatively wide exposure of the muscle, because the FDP muscle is in the deep portion of the forearm.

Patient concerns: In this report, the case of a 35-year-old woman with localized type Volkmann's contracture is presented. Her left forearm had been compressed with an industrial roller 4 months earlier, and severe flexion contracture of the long finger and mild flexion contracture of the ring finger developed gradually. DIAGNOSES:: localized type Volkmann's contracture.

Intervention: Five months after the injury, transection of the FDP tendon to the long finger and transfer of the transected tendon to the FDP tendon to the index finger was performed after adjusting the tonus of these two tendons using a small skin incision. This procedure was followed by a tension-reduced early mobilization technique in which a tension-reduced position of the tendon suture site was maintained by taping the long finger to the volar side of the index finger, and then immediate active range of motion (ROM) exercise was started.

Outcomes: Within 9 weeks after surgery, full ROM had been regained.

Lessons: Using the treatment procedure presented in this case report, a good clinical result was obtained in a minimally invasive manner.

Figure 1

Preoperative findings of the left hand. (A, B) The long finger shows severe flexion contracture, and the ring finger shows a mild flexion contracture with the wrist in the neutral position. (C) The flexion contractures of these 2 fingers are reduced with the wrist in the palmar flexion position.

Figure 2

Intraoperative findings. (A) The FDP tendon to the long finger has lost its mobility because of muscle contracture. (B) By transecting the FDP tendon to the long finger, the flexion contracture of the long finger is reduced. (C) The distal stump of the transected tendon has been transferred to the FDP tendon to the index finger. FDP = flexor digitorum profundus.

Figure 3

Tension-reduced early mobilization. The tension-reduced position is maintained by taping the long finger to the volar side of the index finger, with active ROM exercise started immediately after the surgery. ROM = range of motion.

Figure 4

To prevent recurrence of flexion contracture of the fingers, the extension position of the fingers is maintained with a night splint.

Figure 5

Physical findings at final observation. Full finger flexion and extension have been obtained in all fingers.