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. 2024 Nov 13;51(6):561-567.
doi: 10.1055/a-2398-9052. eCollection 2024 Nov.

Severe Flexor Digitorum Profundus Muscular Adhesion by Pseudo-Volkmann's Contracture without Fracture: A Case Report and Literature Review

Jae Woo Kim  1 , Jong Chan Kim  2 , Sung Hoon Koh  1 , Jin Soo Kim  1 , Si Young Roh  1 , Kyung Jin Lee  1 , Dong Chul Lee  1
Affiliations

Severe Flexor Digitorum Profundus Muscular Adhesion by Pseudo-Volkmann's Contracture without Fracture: A Case Report and Literature Review

Jae Woo Kim et al. Arch Plast Surg. .

Abstract

Volkmann's ischemic contracture is a condition characterized by permanent ischemic damage to muscles and nerves due to vascular insufficiency, resulting in flexion contractures of the affected limb. In contrast, pseudo-Volkmann's contracture presents with similar clinical features but lacks ischemic damage and has the potential for complete recovery. We report a case of a 39-year-old man who developed failure of extension in the middle and ring fingers of the left hand following blunt forearm trauma from a rolling machine. Despite no skin breakage or fracture, his symptoms progressively worsened over 2 months without treatment. Surgical exploration 2 years later revealed severe adhesions of the flexor digitorum profundus muscle at the myotendinous junction to the ulnar periosteum, with immediate recovery after release. This case highlights pseudo-Volkmann's contracture in an adult without fracture, likely due to blunt trauma causing delayed adhesion formation.

Keywords: flexor tendon; posttraumatic adhesion; pseudo-Volkmann's contracture.

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Conflict of interest statement

Conflict of Interest J.S.K. and D.C.L. are editorial board members of the journal but were not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflicts of interest relevant to this article were reported.

Figures

Fig. 1
Fig. 1
Preoperative contracture in the ring and middle fingers. ( A, B ) Preoperative active range of motion (ROM). ( C, D ) Preoperative passive ROM.
Fig. 2
Fig. 2
( A ) Severe adhesions of the flexor digitorum profundus tendon group. ( B ) Innocent median nerve. ( C ) Resected hypertrophic fascia. ( D ) Immediate improvement of extension in the middle and ring fingers.
Fig. 3
Fig. 3
( A, B ) Range of motion in the middle and ring fingers during follow-up at postoperative day 7 showing the ability to extend the involved fingers. ( C ) Although the wrist is extended, slight limitations were observed due to pain. However, passive extension was unimpeded in the affected digits.
Fig. 4
Fig. 4
Contracture recurs mostly in the middle and ring fingers, which was associated with pain in the forearm and transient sensory deficit on the affected hand 2 months after the primary operation.
Fig. 5
Fig. 5
( A ) Ultrasonography reveals hematoma at the proximal one-third of the left flexor digitorum superficialis (FDS) muscle. ( B ) Compression of the median nerve (yellow mark) by encapsulated hematoma. ( C ) Hematoma adhered to both FDP and FDS muscle groups. ( D ) Resected FDS fascia. FDP, flexor digitorum profundus.
Fig. 6
Fig. 6
Improvement of extension in the involved fingers after 3 weeks.
See this image and copyright information in PMC

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