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Case Reports
. 2016 Nov-Dec;6(5):55-58.
doi: 10.13107/jocr.2250-0685.630.

Acute Both Bone Fracture in a Chronic Contracted Forearm

Mark Ayzenberg  1 , Nathan C Tiedeken  1 , Dillon E Arango  1 , James Raphael  1
Affiliations
Case Reports

Acute Both Bone Fracture in a Chronic Contracted Forearm

Mark Ayzenberg et al. J Orthop Case Rep. 2016 Nov-Dec.

Abstract

Introduction: There is a paucity of information on management of forearm fractures through pre-existing ischemic contractures. The prevention of a Volkmann's contracture in forearm compartment syndrome requires vigilant clinical evaluation and emergent fasciotomy, but many of the patients who develop these contractures often do so as a result of delayed presentation due to substance abuse and intoxication. This case describes the first report and management of a severely displaced both bone (BB) forearm fracture through a chronic forearm Volkmann's contracture.

Case report: A 39 year old female presented with an acute both bone forearm fracture in the setting of a Volkmann's contracture. Although very limited in use, the arm was functional for holding objects and was determined to be important in her activities of daily living. The surgical management involved open reduction internal fixation with radial and ulnar shortening osteotomies to restore cortical alignment secondary to the extensive overlying soft tissue contractures.

Conclusion: Restoration of the radial bow and other standard principles of open reduction and internal fixation of BB fractures may not be as important as obtaining fracture union in patients with these complicated injuries due to the pre-existing functional limitations of the limb. The soft tissue envelope in a contracted forearm is commonly fibrotic and provides an abnormal fracture healing environment. Careful attention to osseous and soft tissue healing in the postoperative period is recommended. This report details the first case, technical difficulties, and subsequent management of a BB fracture in the setting of subsequent management of a both bone fracture in the setting of a chronic Volkmann's contracture.

Keywords: Both bone fracture; Volkmann’s contracture; compartment syndrome.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Anteroposterior and lateral radiographs of the right forearm demonstrating a severely displaced, rotated, and shortened both bone forearm fracture.
Figure 2
Figure 2
Posteroanterior and lateral postoperative radiograph of the right forearm demonstrating restoration of cortical alignment of radius and ulna with intact hardware.
Figure 3
Figure 3
Post-operative clinical photograph of severely contracted right forearm.
See this image and copyright information in PMC

References

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