J Korean Orthop Assoc.  2017 Aug;52(4):364-369. 10.4055/jkoa.2017.52.4.364.

Delayed Rupture of the Extensor Pollicis Longus Tendon Following Intramedullary Nailing of Radial Shaft Fracture

Affiliations
  • 1Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea. Lacteaa@naver.com

Abstract

Delayed rupture of the extensor pollicis longus tendon mostly occur after plate fixation of distal radius fracture. However, delayed rupture of the extensor pollcis longus tendon following intramedullary nailing of radial shaft fracture is very rare. We report one case of delayed rupture of the extensor pollicis longus tendon following intramedullary nailing, presenting abnormal signs from adhesion of the extensor pollicis longus with extensor indicis at the nail insertion site.

Keyword

tendon injuries; tendon transfer; radius fractures

MeSH Terms

Fracture Fixation, Intramedullary*
Radius Fractures
Rupture*
Tendon Injuries
Tendon Transfer
Tendons*

Figure

  • Figure 1 (A) Preoperative radiographs show radius shaft fracture. (B) Postoperative radiographs show the fracture treated with closed reduction and internal fixation using interlocking nail.

  • Figure 2 Ultrasonography showed loss of continuity of the extensor pollicis longus (arrow).

  • Figure 3 (A) Appearance of the distal ends of the ruptured extensor pollicis longus tendon. (B) Harvest of the extensor indicis tendon on metacarpophalangeal joint dorsal aspect. (C) The tendon transfer is done with the extensor indicis tendon.

  • Figure 4 (A) Abnormal signs included inability to extend the thumb when the second finger was in flexion. (B) But the thumb was able to be extended when the 2nd finger was in extension.

  • Figure 5 We performed adhesiolysis on the site of tendon transfer and interlocking nail insertion site.

  • Figure 6 Last follow-up. Note: full extension and dorsal elevation of thumb without extension of the 2nd finger.


Reference

1. Lee YH, Lee SK, Chung MS, Baek GH, Gong HS, Kim KH. Interlocking contoured intramedullary nail fixation for selected diaphyseal fractures of the forearm in adults. J Bone Joint Surg Am. 2008; 90:1891–8.
Article
2. Herron M, Faraj A, Craigen MA. Dorsal plating for displaced intra-articular fractures of the distal radius. Injury. 2003; 34:497–502.
Article
3. Oh JR, Ryu HY, Kwon SM, Chung HJ. Reconstruction of the extensor pollicis longus tendon by tendon graft or tendon transfer. J Korean Soc Surg Hand. 2009; 14:199–204.
4. Christophe K. Rupture of the extensor pollicis longus tendon following colles fracture. J Bone Joint Surg. 1953; 35:1003–5.
Article
5. Stahl S, Calif E, Eidelman M. Delayed rupture of the extensor pollicis longus tendon following intramedullary nailing of a radial fracture in a child. J Hand Surg. 2007; 32:67–8.
Article
6. Hirasawa Y, Katsumi Y, Akiyoshi T, Tamai K, Tokioka T. Clinical and microangiographic studies on rupture of the E.P.L. tendon after distal radial fractures. J Hand Surg Br. 1990; 15:51–7.
Article
7. Björkman A. Jörgsholm P. Rupture of the extensor pollicis longus tendon: a study of aetiological factors. Scand J Plast Reconstr Surg Hand Surg. 2004; 38:32–5.
8. Failla JM, Koniuch MP, Moed BR. Extensor pollicis longus rupture at the tip of a prominent fixation screw: report of three cases. J Hand Surg Am. 1993; 18:648–51.
Article
9. Jubel A, Andermahr J, Isenberg J, Issavand A, Prokop A, Rehm KE. Outcomes and complications of elastic stable intramedullary nailing for forearm fractures in children. J Pediatr Orthop B. 2005; 14:375–80.
Article
10. Riddell DM. Spontaneous rupture of the extensor pollicis longus: the results of tendon transfer. J Bone Joint Surg Br. 1963; 45:506–10.
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