Longstanding Volkmann ischemic contracture of the forearm following traditional bonesetter practice successfully treated with combined flexor origin slide and tendon transfer: A case report

INTRODUCTION AND IMPORTANCE: The Volkman ischemic contracture (VIC) of the forearm is a sequel of the compartment syndrome of the forearm. There were no studies reported the outcome of surgical treatment for VIC, particularly the muscle origin slide procedure, in treating the VIC that had been developed more than 20 years. CASE PRESENTATION: We reported a 34 years old right-hand dominant painter with fingers flexion contracture, decreased hand mobility and sensation on her right hand. She had history of closed right forearm fracture when she was 10 years old that was treated by a traditional bonesetter. A week afterward, she experienced clinical presentation of compartment syndrome. Not long thereafter, the pain subsided but she started to have stiffness and discomfort in her forearm and hand condition. Twenty-four years later, she wants to get treatment for her hand. We diagnosed her with VIC, moderate degree based on Tsuge Classification. We then performed flexor origin slide procedure and tendon transfer. In 1.5 year of follow-up, a satisfactory functional outcome was noted. CLINICAL DISCUSSION: Flexor origin slide was the preferred treatment if the flexors still retain adequate strength. During the surgery, severe degeneration of FPL and FDP was found. Therefore, we performed tendon transfer to increase the grip strength. CONCLUSION: VIC is not uncommon following fracture treated in the traditional bonesetter. For moderate VIC, the flexor origin slide procedure and tendon transfer could still give benefit, even in the case of treatment delay of more than 20 years from onset.