Concurrent Flexor Carpi Radialis Tendon Rupture and Distal Radius and Ulna Fractures

Background: Distal ulna fractures at the ulnar neck can be seen in association with distal radius fractures, and multiple techniques have been described to address the ulnar neck component of these injuries. We have found that treatment of ulnar neck fractures can be challenging in terms of anatomy and fracture fixation. We present a new percutaneous fixation technique for ulnar neck fractures commonly seen with distal radius fractures. Technique: Fixation of the ulnar neck fracture is performed after fixation of the distal radius fracture. Our technique uses anterograde intramedullary fixation to stabilize the fracture with a 1.6-mm (0.062 inch) Kirschner wire or a commercially available metacarpal fixation intramedullary nail. The fixation is introduced into the intramedullary space of the ulnar shaft 4 to 6 cm proximal to the fracture at a separate surgical site along the subcutaneous border of the ulna. The fixation is also supported with a sugar-tong splint for the first few weeks after surgery and requires removal of the ulnar implant approximately 10 weeks after implantation. Conclusion: Our technique utilizes a percutaneous approach with minimal fracture exposure. It provides a relatively simple and reproducible method to address ulnar neck fractures commonly seen in association with distal radial fractures.

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Evaluation of Flexor Pollicis Longus Tendon Rupture after Treatment of Distal Radius Fracture with the Volar Plate

Journal of Wrist Surgery ◽

10.1055/s-0040-1702931 ◽

2020 ◽

Vol 09 (03) ◽

pp. 219-224 ◽

Cited By ~ 1

Author(s):

Kamil Yamak ◽

Hüseyin Gökhan Karahan ◽

Berrak Karatan ◽

Cemil Kayalı ◽

Taşkın Altay

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Tendon Rupture ◽

Flexor Tendon ◽

Plate Fixation ◽

Volar Plate ◽

Flexor Pollicis Longus ◽

Radius Fractures ◽

Volar Plate Fixation

Abstract Background The aim of this study is to evaluate the frequency of flexor pollicis longus (FPL) tendon rupture and factors leading to this rupture during the follow-up of patients who underwent volar plate fixation because of distal radius fracture. Patients and Methods A total of 109 distal radius fractures of 102 patients treated with volar plate fixation and periodically followed up for at least 1 year between January 2013 and May 2018 were evaluated. Fractures were categorized according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) Fracture-Dislocation Classification and Soong's grading was used for classifying volar plate position. All patients operated were inquired retrospectively in terms of flexor tendon rupture. Results Gender distribution revealed 45 females and 57 males. Mean age was 47.9 (range: 17–88) years. Mean period of follow-up was 27 months. Distribution of fractures in accordance with the AO/OTA distal radius classification was 6, 8, 7, 12, 24, 33, 11, and 8 patients with types A2, A3, B1, B2, B3, C1, C2, and C3, respectively. When volar plate positions were analyzed with Soong's classification, it revealed that 79 (72.4%), 23 (21.1%), and 7 (6.5%) plates were grade 0, 1, and 2, respectively. In total, evaluating the three patients with FPL rupture, it revealed that the volar plate was positioned distally during fixation because the fracture line had advanced to the distal of the watershed line, the distal portion of the plate had lost complete connection with the bone, and at this portion, it was observed that the pronator quadratus muscle was not covering the plate entirely (Soong's classification grade 2). Patients did not have additional flexor tendon injury. Conclusion FPL tendon rupture is a rare but serious complication of volar plate fixation performed for distal radius fractures. We believe that appropriate choice of implant and careful surgical technique, along with the close follow-up of patients, with Soong's classification grade-2 volar positions would help in preventing this complication. Level of Evidence This is a Level 3a, differential diagnosis/symptom prevalence study.

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Flexor Pollicis Tendon Rupture After Volar Plating of Distal Radius Fracture

Journal of Orthopaedics and Sports Medicine ◽

10.26502/josm.511500027 ◽

2020 ◽

Vol 02 (02) ◽

Author(s):

Amanda Partap ◽

Trevor Seepaul ◽

Ryan Raghunanan

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Tendon Rupture ◽

Radius Fracture ◽

Volar Plating

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Proposed Guidelines for Treatment of Concomitant Distal Radius and Distal Ulna Fractures

Hand Surgery ◽

10.1142/s0218810415500306 ◽

2015 ◽

Vol 20 (03) ◽

pp. 396-401

Author(s):

Benjamin Liang ◽

Jen Ming Lai ◽

Arul Murugan ◽

Kin Ghee Chee ◽

Sreedharan Sechachalam ◽

...

Keyword(s):

Internal Fixation ◽

Distal Radius ◽

Distal Ulna ◽

Non Union ◽

Cast Immobilisation ◽

Group 4 ◽

Ulna Fractures ◽

Group 2 ◽

Both Bones ◽

Group 1

Background: Concomitant distal radius and distal ulna metaphysis or head fractures (DRUF) are uncommon and acceptable results have been reported from cast immobilisation and internal fixation. Methods: We reviewed the charts of 1094 patients treated for distal radius fracture at our institution in a two year period from 2009 to 2010. 24 patients with concomitant DRUF with were treated by cast immobilisation (group 1, n = 11), internal fixation of both bones (group 2, n = 7), internal fixation of radius alone (group 3, n = 2), and internal fixation of radius with distal ulna resection (group 4, n = 4). Patients treated by surgery underwent intraoperative assessment of distal ulna stability to determine the indication for ulna fixation. Post surgical range of motion, clinical parameters, and functional outcome scores (Gartland-Werley and modified Mayo) were measured. Results: Wrist motion was comparable in each group. Radiographic parameters were better in surgical groups. 23 of 24 patients achieved excellent/good outcomes based on Gartland-Werley scores, while 12 of 24 achieved good modified Mayo wrist score. There was a case of distal ulna non-union in group 1, and another case of delayed distal radius union in group 2. Conclusions: By evaluating patients’ functional requirement, and dynamic fluoroscopy examination, satisfactory outcomes can be achieved for various presentations of DRUF.

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Titanium Elastic Nails for Distal Radius-ulna Fractures in Young Dogs

Indian Journal of Animal Research ◽

10.18805/ijar.b-4509 ◽

2021 ◽

Author(s):

Harmanpreet Singh Sodhi ◽

Ashwani Kumar ◽

Arun Anand ◽

Vandana Sangwan ◽

Dhiraj Kumar Gupta

Keyword(s):

Distal Radius ◽

Bone Fractures ◽

Weight Bearing ◽

Medullary Canal ◽

Long Term Results ◽

Long Bone ◽

Uneventful Recovery ◽

Fractures In Children ◽

Ulna Fractures ◽

Elastic Nails

Background: Radius-ulna is the most frequently fractured bone of the pectoral limb in dogs with high predisposition to distal fractures. The smaller size of the distal fragment and open physis restrict the use of rigid fracture fixation techniques in distal fractures of growing dogs. Titanium elastic nails (TENs) are recommended in medical practice to stabilize long bone fractures in children. There is paucity of literature on TENs for the repair of radius-ulna fractures in dogs. Methods: This clinical study enrolled 10 dogs (7 grey hound and one each of Crossbred, Pomerenarian and Siberian Husky) suffering from distal radius-ulna (6 transverse and 4 short oblique) fractures since a mean ± SD duration of 3.40±4.5 days. The mean ± SD age and body weight of the dogs was 12.60±6.45 months and 14.09±6.41 Kg, respectively. All except one fracture was stabilized with two TENs inserted into the medullary canal of radial bone in a normograde manner from distal to proximal end using open cranio-lateral surgical approach. Result: Majority fractures achieved satisfactory reduction (n=8), radiographically. Weight bearing scores on walking increased gradually from day 12 (1.62 ± 1.51) to 45th (2.57±1.51), day 60th (3.75±0.5) and day 90 (4.0±0). Five dogs had uneventful recovery whereas remaining had major (n=2) or minor (n=3) complications. The length of the operated bone was non-significantly lesser as compared to contralateral healthy bone on day 60. Goniometric assessment of carpal joint of operated limb showed restricted range of motion on day 12 that improved to the near normal as contralateral healthy limb on day 60. Long-term results showed full (9) and acceptable (1) functional outcome. In conclusions, the TENs technique is simple and less invasive alternative fixation technique for distal radius-ulna fractures in young and light weighing dogs. As per authors, this is the first report on the use of TENs for the management of radius-ulna fracture in dogs.

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