Flexor Tendon Entrapment at the Malunited Base Fracture of the Proximal Phalanx of the Finger in Child

Abstract

The proximal phalangeal base is the most commonly fractured hand bone in children. Such fractures are rarely reported as irreducible due to flexor tendon entrapment. Here, we describe a patient who sustained a malunited fracture on the right fifth finger proximal phalanx with flexor tendon entrapment after treatment with closed reduction with K-wires fixation.A 13-year-old patient came to the clinic following a bicycle accident 6 weeks ago. He presented with flexion limitation in his small finger on the right hand. During physical examination, the patient felt no pain, and the neurovascular structures were intact. However range of motion (ROM) in his small finger was not normal. Plain radiographs displayed a Salter–Harris type II fracture of the small finger proximal phalanx base and volar angulation with callus formation. During the operation, it was established that the flexor digitorum superficialis (FDS) around the fracture had a severe adhesion, whereas the flexor digitorum profundus (FDP) was entrapped between the volarly displaced metaphyses and the epiphyses and united with the bone. We removed the volarly displaced metaphyses and freed FDP and repaired the A2 pulley. The bone was anatomically fixed with K-wires. In the treatment after the operation, on the 2nd day, the patient was permitted the DIP joint motion by wearing a dynamic splint.At the 12-months follow-up, the patient had regained full ROM with no discomfort and the proximal phalanx growth plate of the small finger closed naturally with normal alignment.When treating a proximal phalangeal base fracture in children, the possibility of flexor tendon entrapment should be considered and should be carefully dealt with in its treatment.

Flexor tendon dysfunction due to a rare fracture of the proximal phalanx: A case report

“…Since its first description by Von Raffler in 1964, only 10 cases of flexor tendon entrapment in a proximal phalangeal fracture have been reported in the English-Language literature. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 Previous reports describe the complication in association with displaced epiphyseal and diaphyseal fractures. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 In this case, however, the inability to actively flex the affected finger was the result of an unusual fracture configuration of the proximal phalanx.…”

“…1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 Previous reports describe the complication in association with displaced epiphyseal and diaphyseal fractures. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 In this case, however, the inability to actively flex the affected finger was the result of an unusual fracture configuration of the proximal phalanx. A small bony fragment directly impinged the flexor tendons preventing their function.…”

Presentation and aetiology of paediatric trigger finger: a systematic review

“…Though not included in this review, multiple reports described reduced digit range of motion associated with hand or forearm fractures, a presentation that mimics trigger finger (Fernandez and Segal, 2007;Furuya et al, 2019;Harryman and Jordan, 1990;Lee et al, 2015;Ooi and Toh, 2001;Piquilloud et al, 2011;Rayan and Hayes, 1986;Rodrı ´guez-Vega et al, 2013;Shaw and Murphy, 1996;Shively and Lesnick, 1982;Song et al, 2012;Walker et al, 2012).…”

A Rare Cause of Locked Pinky in a Golfer: A Clinical Vignette

“…Trigger fingers are typically caused by flexor tendon sheath hypertrophy or thickening of the A1 pulley. Other rare causes of trigger finger include anatomical variation of the lumbrical muscle, 1 postsurgical anatomical changes of the fractured proximal phalanx, 2 sesamoid arthritis of the fingers, 3 and the presence of ganglion cyst on the flexor tendon sheath 4 …”