Biceps Transfer to FDP–FPL Tendon Augmented with Fascia Lata to Restore Hand Function in Neglected Fracture Treated by Traditional Bone-setters

Abstract

Summary:. Neglected bone fractures owing to the traditional bone-setter practices could lead to devastating complications. We aimed to describe the procedure and outcome of fascia lata augmentation for a forearm massive soft tissue loss case. Here, we report a case of a 14-year-old boy who presented to our hospital with a history of neglected right forearm fracture 4 years prior. He had been treated by a traditional bone-setter instead of seeking professional medical help, which resulted in wide-spread infection requiring debridement and, eventually, massive soft tissue loss, wrist radial deviation deformity due to epiphyseal growth arrest, and loss of all right-hand function. Intervention performed was biceps transfer to flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) tendon augmented with fascia lata with anterior capsulectomy, bilobed flap, and transfixing wire of wrist joint, followed by ulnar centralization with wrist arthrodesis. The patient reported satisfaction postreconstruction, owing to the enhancement of hand function and appearance. He also showed significant improvement in activities of daily living and penmanship, and was even able to continue his old hobby as a traditional puppeteer. Autologous fascia lata tendon transfer connecting biceps to FDP and FPL tendon alongside ulnar centralization with wrist arthrodesis is a novel technique that has promising results to improve hand function and appearance.