Journal of Musculoskeletal Trauma

Radiologic Analysis of Distal Radius Fracture Accompanying Spontaneous Extensor Pollicis Longus Rupture: Jun Ku Lee, In Tae Hong, Young Woo Kwon, Gyu Chol Jang, Soo Hong Han; J Korean Fract Soc 2017;30(2):63-68. Published online April 30, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.2.63

Abstract PDF: PURPOSE
The spontaneous extensor pollicis longus (EPL) tendon rupture is a well-documented complication of non-displaced or minimally displaced distal radius fracture. Authors analyzed the radiographs of patients treated for closed EPL rupture after distal radius fracture.
MATERIALS AND METHODS
Twenty-eight patients (21 females, 7 males; average age of 58 years) with tendon transfer for spontaneous rupture of EPL after distal radius fracture were included. Wrist radiographs were taken at the first visit with EPL rupture. On the lateral view, posterior cortical displacement, distance from highest point in Lister's tubercle to fracture line, and height of the Lister's tubercle were measured. The distance from the lunate facet to the fracture line was measured on anteroposterior view. Radiologic change at the time of EPL rupture around the Lister's tubercle was evaluated by comparing it with the contra lateral wrist radiograph. Radial beak fracture pattern was also identified.
RESULTS
The interval between the injury and the spontaneous EPL rupture varied from 2 to 20 weeks, with an average of 6.7 weeks. There were 25 cases of non-displacement, 3 cases of mean 2.0 mm cortical displacement. The average distance from the lunate facet to the fracture line was 9.1 mm (3-12.1 mm), from the highest point in Lister's tubercle to the fracture line was 3.0 mm toward proximal radius (1.7-4.9 mm). The average height of the Lister's tubercle was 3.4 mm in the injured wrist and 3.1 mm in the opposite wrist. Radial beak fracture pattern was shown at 11 cases.
CONCLUSION
All cases presented no or minimal displaced fracture, and the fracture line was in the vicinity of the Lister's tubercle. Those kinds of fractures can highlight the possibility of spontaneous EPL rupture, depites its rarity.

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Rupture of the Extensor Pollicis Longus Tendon at the Proximal Screw of Volar Plate Fixation for Distal Radius Fracture: A Case Report: Dong Ju Shin, Seung Oh Nam, Hun Sik Cho; J Korean Fract Soc 2013;26(4):338-342. Published online October 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.4.338

Abstract PDF: As volar plate fixation of distal radius fracture becomes more common, reports of ruptured extensor pollicis longus tendon by a protruding distal screw tip are also increasing steadily. Authors have experienced a rare case of ruptured extensor pollicis longus tendon at the prominent proximal screw of fixed volar plate for distal radius fracture, and we report it herein with a review of the literature.

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Interposition of Extensor Pollicis Longus Tendon in Smith's Fracture in a Child: A Case Report: Seung Ju Jeon, Haeng Kee Noh, Do Yeon Kim, Sung Hoon Jung, Jun Beum Shin, Ho Seung Jeon; J Korean Fract Soc 2013;26(1):65-68. Published online January 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.1.65

Abstract PDF: Entrapment of the extensor pollicis longus tendon is reported rarely on Smith's fractures in children. In our case, a 15 year old boy with Smith's fracture received treatment of closed reduction at another hospital. When he visited our hospital, a wide gap at the fracture site was detected on radiograph and the thumb movement was limited. We have doubt the entrapment of the soft tissue, especially the tendon. We decided on open reduction. In the operation field, entrapment of the extensor pollicis longus tendon at the gap of the fracture site was found through dorsal approach. In addition, fracture treatment with K-wire fixation after reduction of extensonr pollicis longus tendon reduction was done. Therefore, we report this case with a review of the literatures.

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Extensor Pollicis Longus Rupture after Distal Radius Fracture: Nam Young Cho, Chang Young Seo, Myung Sun Kim, Ha Sung Kim, Keun Bae Lee; J Korean Fract Soc 2012;25(1):52-57. Published online January 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.1.52

Abstract PDF

PURPOSE
To evaluate the cause and surgical outcome of extensor pollicis longus rupture after distal radius fractures.
MATERIALS AND METHODS
Nineteen cases in which the patients underwent surgical treatment for rupture of the extensor pollicis longus after distal radius fractures were followed for more than one year. Among the nineteen cases, fourteen extensor pollicis longus ruptures occurred after conservative treatment, four occurred after closed reduction with K-wire fixation, and one occurred after open reduction and internal fixation with a plate. All cases were treated by extensor indicis proprius transfer.
RESULTS
Extensor pollicis longus ruptures were caused by K-wire irritation in two, by a protruding screw tip in one, and by a callus in one. In the conservative treatment group, tendon ruptures were diagnosed at an average of 3.1 months (0.7~17). Tendon ruptures were detected in the surgical treatment group at an average of 12.8 months (1~48). All the patients showed favorable recovery of the extension capability of the thumb at the final follow-up.
CONCLUSION
The main cause of extensor pollicis longus rupture after distal radius fracture was ischemic damage. Therefore, during the surgery, the length and direction of screws and K-wires should be fixed carefully to avoid such damage. Distal radius fracture also requires careful observation of the extensor pollicis longus during follow-up. Furthermore, extensor indicis proprius transfer is considered to be an effective method for extensor pollicis longus rupture.

Citations

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Radiologic Analysis of Distal Radius Fracture Accompanying Spontaneous Extensor Pollicis Longus Rupture
Jun-Ku Lee, In-Tae Hong, Young-Woo Kwon, Gyu-Chol Jang, Soo-Hong Han
Journal of the Korean Fracture Society.2017; 30(2): 63. CrossRef
Assessment of penetration of dorsal screws after fixation of the distal radius using ultrasound: cadaveric study
D Williams, J Singh, N Heidari, M Ahmad, A Noorani, L Di Mascio
The Annals of The Royal College of Surgeons of England.2016; 98(2): 138. CrossRef
Rupture of the Extensor Pollicis Longus Tendon at the Proximal Screw of Volar Plate Fixation for Distal Radius Fracture - A Case Report -
Dong-Ju Shin, Seung-Oh Nam, Hun-Sik Cho
Journal of the Korean Fracture Society.2013; 26(4): 338. CrossRef

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Delayed Rupture of the Extensor Pollicis Longus due to Fracture of the distal radius: A Case Report: Soo Jae Yim, Yeon Cheol Jeong, Seung Ryeol Yoon, Joong Geun Choi, You Sung Suh, Soo Kyun Rah; J Korean Soc Fract 1999;12(1):162-165. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.162

Abstract PDF

After distal radius fracture, delayed rupture of extensor pollicis longus is rare. It is known that delayed rupture of extensor pollicis longus tendon result from undisplaced distal radius fracture. We have experienced a case of rupture of the extensor pollicis longus tendon after undisplaced distal radius fracture, and treated with palmaris longus tendon graft. the result were satisfactory without complications.

Citations

Citations to this article as recorded by

Extensor Pollicis Longus Rupture after Distal Radius Fracture
Nam-Young Cho, Chang-Young Seo, Myung-Sun Kim, Ha-Sung Kim, Keun-Bae Lee
Journal of the Korean Fracture Society.2012; 25(1): 52. CrossRef
Flexor Pollicis Longus Tendon Rupture as a Complication of a Closed Distal Radius Fracture - A Case Report -
Do-Young Kim, Eun-Min Seo, Woo-Dong Nam, Seung-Jae Park, Sang-Soo Lee
Journal of the Korean Fracture Society.2011; 24(2): 191. CrossRef

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Traumatic Rupture of the Extensor Pollicis Longus Tendon Associated with Smiths Fracture: A case report: Keun Woo Kim, Yeng Boon Kim, Pil Gu Yi, Rak Jin Min, Ui Seoung Yoon, Yeng Ryeog Kang; J Korean Soc Fract 1994;7(2):279-283. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.279

Abstract PDF: As a complication of Smiths fracture, traumatic entrapment and closed rupture of the extensor pollicis longus tendon may occur rarely at the fracture site and cause loss of thumb extenion. Traumatic entrapment of the extensor pollicis longus tendon in Smiths fracture which was anatomic barrier of successful closed reduction was first described by Hunt in 1969. Since then, several authors reported another few cases. The mechanism of tendon rupture in Smiths fracture is thought that the sharp dorsal edge of the proximal fragment may tear the stretched muscular tendon unit during extreme wrist flexion. We experienced a case of traumatic rupture of the extensor pollicis longus tendon associated with a closed Smiths fracture and report this case with our treatment method.

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