Arch Hand Microsurg.  2018 Jun;23(2):87-92. 10.12790/ahm.2018.23.2.87.

Delayed Rupture of Flexor Tendons due to a Malunion of Distal Radius Fracture

• Kim TG
• Heo YM
• Yi JW
• Oh BH
• Ham CU

• KMID: 2412477
• DOI: http://doi.org/10.12790/ahm.2018.23.2.87

Abstract

Tendon ruptures of the finger may occur due to various causes around the wrist. Because the malunion of distal radius affects the morphology of distal radioulnar joint (DRUJ), it may cause an arthritis of this joint. Progression of arthritis of the DRUJ may result in bony spurs, dislocation of ulnar head, or change of inclination of sigmoid notch. These changes can cause the attritional rupture of tendons around the DRUJ. We experienced an attritional rupture of 4/5th flexor tendons in a patient with arthritis of the DRUJ and palmar subluxation of ulnar head caused by malunion of distal radius. Although an attritional rupture of flexor tendons is less common than that of extensor tendons, progression of attritional ruptures and management are similar. However, because there are some differences between the former and the latter in radiologic findings and surgical considerations, we report this case with a review of the literature.

Keyword

Distal radius; Distal radioulnar joint; Malunion; Arthritis; Flexor tendon rupture

MeSH Terms

Arthritis
Colon, Sigmoid
Dislocations
Fingers
Head
Humans
Joints
Radius Fractures*
Radius*
Rupture*
Tendons*
Wrist

Figure

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  Fig.1. Clinical photographs showing volar swelling of left wrist (A) and limitation of active flexion of the left fourth and fifth fingers (B).

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  Fig.2. (A, B) Plain radiographs showed malunion of the distal radius associated with arthritis of distal radioulnar joint and palmar subluxation of ulnar head. And deepening and widening of the sigmoid notch was confirmed on postero-anterior view, that reported as the ‘scallop sign’. (C, D) Magnetic resonance imaging showed attritional tenosynovitis of flexor tendons due to the palmar bony spur of ulnar head on sagittal image and increased palmar inclination of the sigmoid notch on axial image.

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  Fig.3. Intraoperative photograph showing severe compression of median nerve, rupture of flexor digitorum profundus tendon of 4th finger and flexor digitorum profundus/superficialis tendon of 5th finger, and rupture of distal radioulnar joint capsule after flexor teno-synovetomy and carpal tunnel release.

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  Fig.4. Radiographs at 6 months follow-up.

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