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.	王樂, 方有生, 徐秀玥, 等. 兒童前臂缺血性肌攣縮的手術療效分析. 中華手外科雜志, 2022, 38(3): 190-191.
2.	張沈煜, 周俊明. 家院配合治療兒童前臂缺血性肌攣縮. 中華手外科雜志, 2020, 36(2): 154-155.
3.	曾裴, 楊建平. 兒童前臂筋膜室間隔綜合征不同時期治療結果比較. 中華手外科雜志, 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.	黨洪勝, 張世瓊, 王平年, 等. 指深屈肌腱粘連致假性缺血性肌攣縮的臨床分析. 中華手外科雜志, 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.	李炳萬, 李大村, 李中檀. 前臂屈肌群起點下移治療前臂缺血性肌攣縮. 中華手外科雜志, 1996, 12(2): 86-88.
10.	張秀芳, 張明, 周敬杰, 等. 虛擬情景反饋訓練對Ⅱ區指屈肌腱損傷修復術后患者手功能恢復的影響. 中華物理醫學與康復雜志, 2017, 39(8): 614-617.
11.	朱嬋, 易南, 石夢娜, 等. 功能訓練聯合自制手屈曲訓練帶治療手背部燒傷后瘢痕攣縮的效果觀察. 中華燒傷雜志, 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. 王樂, 方有生, 徐秀玥, 等. 兒童前臂缺血性肌攣縮的手術療效分析. 中華手外科雜志, 2022, 38(3): 190-191.
2. 張沈煜, 周俊明. 家院配合治療兒童前臂缺血性肌攣縮. 中華手外科雜志, 2020, 36(2): 154-155.
3. 曾裴, 楊建平. 兒童前臂筋膜室間隔綜合征不同時期治療結果比較. 中華手外科雜志, 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. 黨洪勝, 張世瓊, 王平年, 等. 指深屈肌腱粘連致假性缺血性肌攣縮的臨床分析. 中華手外科雜志, 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. 李炳萬, 李大村, 李中檀. 前臂屈肌群起點下移治療前臂缺血性肌攣縮. 中華手外科雜志, 1996, 12(2): 86-88.
10. 張秀芳, 張明, 周敬杰, 等. 虛擬情景反饋訓練對Ⅱ區指屈肌腱損傷修復術后患者手功能恢復的影響. 中華物理醫學與康復雜志, 2017, 39(8): 614-617.
11. 朱嬋, 易南, 石夢娜, 等. 功能訓練聯合自制手屈曲訓練帶治療手背部燒傷后瘢痕攣縮的效果觀察. 中華燒傷雜志, 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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