Pseudo-Volkmann Contracture: A Case Report

Pseudo-Volkmann contracture, also known as entrapment of the flexor muscles, occurs due to mechanical entrapment of the flexor myotendinous units in the fracture or adhesions after both bone forearm fractures. It differs from Volkmann contracture in that there is no ischemia or compartment syndrome, and there is an absence of muscle fibrosis intra-operatively. Patients with pseudo-Volkmann contracture typically present with an inability to extend the fingers passively or actively when the wrist is in extension. However, finger extension is possible when the wrist is flexed. We present the case of a 16-year-old female who developed pseudo-Volkmann contracture subsequent to sustaining a both bone forearm fracture at the age of 4. Despite early recognition of finger flexion issues, the diagnosis was delayed until the age of 16 due to parental reassurance. Consequently, further medical consultation was not sought as the child exhibited satisfactory functional abilities. Understanding these complications is crucial for administering appropriate treatment and mitigating the risk of long-term issues such as flexion contracture.

A review of scaphoid fracture, treatment outcomes, and consequences

PURPOSE

Scaphoid fractures are the most common carpal fracture and can lead to severe complications like carpal collapse and osteoarthritis. This study reviewed scaphoid fracture patterns, outcomes, and consequences in conservative and surgical management.

METHODS

Sixty-four patients with scaphoid fracture who attended the hand clinic at King Hussein Medical City from January 2022 to December 2022 were included and reviewed regarding the anatomical fracture site, the associated injury, the treatment modality (conservative versus surgical), the healing time, and fracture sequelae such as nonunion and scaphoid nonunion advanced collapse.

RESULTS

Most patients were males (62 patients, 96.9%), and most (47, 73.4%) fell within 25 to 40 years. Scaphoid waist fracture was the most common location (40, 52.5%). Most patients (47, 73.4%) received conservative treatment and 17 (26.6%) were fixed acutely. However, nonunion complicated 53 fractures (82.8%). Notably, there were no differences in the union rate or time between cases of scaphoid nonunion treated with vascularized or nonvascularized grafts. Furthermore, there were no variations in union rates among genders, extremities, age, fracture locations, or among smokers. However, a higher union rate was noted in office workers and those who received conservative treatment.

CONCLUSION

Nonunions were higher in our study than in the literature, as our department is a referral center for established nonunion cases. For conservative treatment, we recommend aggressive management and follow-up with a clinical and CT scan at three months and early referral of non-united fractures to the hand clinic to avoid the advanced collapse of the scaphoid.

Pediatric Kienböck's Disease in an 11-Year-Old Boy: A Case Report

Kienböck's disease is a rare condition in the pediatric age group, with little agreement on its natural history and the best treatment option. Typically, these patients present with vague wrist pain and a variable degree of joint motion restriction. Diagnosis is mainly based on clinical suspicion and MRI findings, as radiographs do not show significant changes in the early stages of the disease. Prognosis is better in children than in adults due to the good healing capacity in this age group. This study will report on an 11-year-old boy diagnosed with Kienböck's disease who underwent surgical treatment to temporarily offload the diseased lunate. Clinical and radiographic recovery was observed at the six-month follow-up.