scholarly journals Drill Penetration Injury to Extensor Tendons: A Biomechanical Analysis

Hand ◽  
2016 ◽  
Vol 12 (3) ◽  
pp. 301-306 ◽  
Author(s):  
Jared M. Mahylis ◽  
Anora K. Burwell ◽  
Laura Bonneau ◽  
Lynn M. Marshall ◽  
Adam J. Mirarchi
Keyword(s):  
Cyclic Loading ◽  
Plate Fixation ◽  
Extensor Tendon ◽  
Tendon Injury ◽  
Biomechanical Analysis ◽  
Extensor Pollicis Longus ◽  
Extensor Tendons ◽  
Fresh Frozen ◽  
Increasing Cyclic Loading ◽  
Extensor Carpi Radialis

Background: Little is known about extensor tendon failure following drill injury at the time of volar plate fixation. Our goals were to analyze extensor tendon injury following simulated drill penetration, and change in tendon displacement during cyclic loading following simulated drill penetration injury. Methods: Extensor pollicis longus (EPL) and extensor carpi radialis brevis (ECRB) tendons were harvested from 9 fresh frozen cadaveric arms. Eighteen EPL and 18 ECRB samples were created from harvested tendons. Drill penetration injury was performed in either a continuous or an oscillating mode. Injured tendons were subjected to 1200 cycles at 1- to 15-kg cyclic load at a frequency of 1 Hz, and analyzed for failure at drill sites and change in displacement throughout the testing cycle. Results: Ten EPL samples and 16 ECRB samples completed testing without failure. Tendon type (ECRB, EPL), mode of injury (continuous, oscillating), and location (proximal, distal) did not affect tendon displacement during loading. A single EPL tendon failed following continuous drill penetration injury. Extensor carpi radialis brevis samples had a mean change in displacement of 2.8 (standard deviation [SD]: 1.5 mm) and 5.9 mm (SD: 4.7 mm) for oscillating and continuous modes, respectively. Six EPL samples had a mean change in displacement of 4.7 (SD: 2.7 mm) and 4.3 mm (SD: 1.8 mm) for oscillating and continuous modes, respectively. Conclusions: Complete extensor tendon failure due to drill penetration was rare. Drill mode did not affect the degree of elongation. Increasing cyclic loading of extensor tendons after drill injury caused modest extensor tendon elongation.

scholarly journals Bridge Plate Failure with Extensor Tendon Injury: A Case Report and Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Rachel Lefebvre ◽  
Jessica Intravia ◽  
Lisa Cao ◽  
Alidad Ghiassi ◽  
Milan Stevanovic
Keyword(s):  
Case Report ◽  
Tendon Transfer ◽  
Plate Fixation ◽  
Extensor Tendon ◽  
Tendon Injury ◽  
Extensor Pollicis Longus ◽  
Bridge Plate ◽  
Important Relationship ◽  
Extensor Carpi Radialis ◽  
Plate Failure

Background. Dorsal spanning plate fixation is an increasingly popular method of fixation for certain distal radius fractures. Published outcomes are encouraging, but complications are still reported. Methods. We present a case report of a 26-year-old woman with spanning plate breakage and extensor pollicis longus (EPL) metallosis, fraying, and near-complete rupture. The patient’s unsuccessful follow-up led to this complication. Metallosis and damage to the extensor indices (EI) and distal extensor carpi radialis longus (ECRL) were intraoperative obstacles for tendon transfer to restore EPL function. Results. Tendon transfer in the setting of bridge plate failure has not yet been described in the literature. There are reports of spanning plate failure indicating that breakage often happens through the plate’s holes and after fracture healing. Conclusions. The compounded complication of plate failure with extensor tendon injury emphasizes the important relationship between the local anatomy, barriers to patient care, and potential problems after spanning plate fixation.

scholarly journals Minimising the risk of extensor pollicis longus rupture following volar plate fixation of distal radius fractures: a cadaveric study

2011 ◽  
Vol 93 (1) ◽  
pp. 57-60 ◽  
Author(s):  
DC Perry ◽  
DMG Machin ◽  
JA Casaletto ◽  
DJ Brown
Keyword(s):  
High Risk ◽  
Distal Radius ◽  
Plate Fixation ◽  
Tendon Injury ◽  
Distal Radius Fractures ◽  
Volar Plate ◽  
Radius Fractures ◽  
Extensor Pollicis Longus ◽  
Fixed Angle ◽  
Volar Plate Fixation

INTRODUCTION Rupture of extensor pollicis longus (EPL) tendon is a recognised complication following volar plate fixation of distal radius fractures, usually from attrition caused by prominent screws. We sought to identify the screw holes in some of the most commonly used plates which may precipitate tendon injury. SUBJECTS AND METHODS Three fixed-angle volar locking plates were sequentially positioned into 18 cadaveric arms. A wire was passed through each of the holes in the plates using a locking guide and the dorsal relationships noted. RESULTS Each plate had specific ‘high-risk’ holes which directed the wire towards the EPL groove. The central screw holes appeared mostly implicated in EPL injury. CONCLUSIONS Awareness of ‘high-risk’ holes and appropriate minor alterations in surgical technique may consequently decrease the incidence of EPL irritation and rupture.

scholarly journals Anatomic Association of the Proximal Fingernail Matrix to the Extensor Pollicis Longus Tendon: A Morphological and Histological Study

2018 ◽  
Vol 7 (12) ◽  
pp. 465 ◽  
Author(s):  
Patricia Palomo-López ◽  
Ricardo Becerro-de-Bengoa-Vallejo ◽  
Daniel López-López ◽  
César Calvo-Lobo ◽  
Manuel Herrera-Lara ◽  
...  
Keyword(s):  
Histological Study ◽  
Extensor Tendon ◽  
Functional Impairments ◽  
Extensor Pollicis Longus ◽  
Longus Tendon ◽  
The Matrix ◽  
Fresh Frozen ◽  
Human Cadavers ◽  
Distal Section ◽  
Extensor Pollicis Longus Tendon

Background: Extensor tendon disorders may cause severe functional impairments, and there is a lack of knowledge about their anatomic associations with the proximal fingernail matrix. Objective: To delineate the association between the distal extensor pollicis longus tendon (EPLT) insertion and the limit of the fingernail matrix in the thumb. Methods: The limit of the fingernail matrix and the distal bony insertion of the EPLT were identified in five thumbs from fresh-frozen human cadavers. An additional five thumbs were fixed and the longitudinal thumb sections were histologically analyzed. Results: The terminal limit of the matrix and fingernail was dorsal and overlapped to the EPL tendon, which was located between the fingernail matrix and the phalanx, and extended dorsally to the distal section of the terminal phalanx in all ten thumb bodies. Conclusion: The fingernail matrix is not directly inserted into the periosteum of the dorsal section of the base to the distal phalanx, because this anatomic relationship is separated by the deep fibers of the EPLT.

scholarly journals MRI Study on the Distance between the Distal Radius and the Flexor and Extensor Tendons: Is There Any Room for Error/Hardware?

2019 ◽  
Vol 08 (06) ◽  
pp. 470-476
Author(s):  
Minke Bergsma ◽  
Jemara Board ◽  
Job N. Doornberg ◽  
Inger Sierevelt ◽  
Mark Rickman ◽  
...  
Keyword(s):  
Distal Radius ◽  
Magnetic Resonance Images ◽  
Dorsal Side ◽  
Flexor Digitorum Profundus ◽  
Dorsal Cortex ◽  
Level Of Evidence ◽  
Extensor Pollicis Longus ◽  
Extensor Tendons ◽  
Flexor Digitorum ◽  
Extensor Carpi Radialis

Abstract Purpose This study aims to quantify the distances between the cortex of the distal radius and flexor and extensor tendons. Methods We analyzed 50 magnetic resonance images (MRI) of intact wrist without pathology. The distances between the volar cortex and the flexor pollicis longs (FPL), index flexor digitorum profunduns (FDPi), flexor digitorum profundus (FDP), and flexor digitorum superficialis (FDS) were measured at the level of the watershed line and 3- and 6-mm proximal to this level. The distances between the dorsal cortex and the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor pollicis longus (EPL), extensor indicis proprius (EIP), and the extensor digitorum communis (EDC) were measured at the level of Lister's tubercle and 5-mm distal to this level. Analysis was descriptive. Results At the watershed line, the FPL, FDPi, FDP, and FDS were located at an average of 3.1, 2.4, 3.6, and 5.1 mm, respectively, volar to the volar cortex. The distances of the FDP and FDS increased at 3-mm proximal to the watershed line and increased for all four tendons at 6-mm proximal to the watershed line. Dorsally, at Listers' tubercle the ECRL, ECRB, EPL, EIP, and EDC were identified at an average of 0.7, 0.5, 0.5, 2.6, and 3.2 mm, respectively, dorsal to the dorsal cortex of the distal radius. At 5-mm more distal, these tendons were located on average 1.2, 1.0, 0.7, 1.9, and 1.8 mm, respectively, dorsal to the dorsal cortex. Conclusion On the volar side, on average there is enough room for a volar plate when staying proximal to the watershed line. On the dorsal side, there is virtually no room for protruding screws as physical anatomical space is limited to a maximum of 0.7 mm from cortex to the closest tendon (the FDP), with screw increments being 2 mm. Level of Evidence This is a Level II Study.

scholarly journals Extensor tendon ruptures in rheumatoid wrists

2020 ◽  
Vol 30 (8) ◽  
pp. 1499-1504
Author(s):  
C. Biehl ◽  
M. Rupp ◽  
S. Kern ◽  
C. Heiss ◽  
T. ElKhassawna ◽  
...  
Keyword(s):  
Extensor Tendon ◽  
Underlying Disease ◽  
Chronic Inflammatory Disease ◽  
Functional Improvement ◽  
Patient Acceptance ◽  
Extensor Pollicis Longus ◽  
Extensor Tendons ◽  
Long Time ◽  
Healthy Control ◽  
Tendon Ruptures

Abstract Background and aims Rheumatoid arthritis is a chronic inflammatory disease. The associated involvement of hands and tendons is over 90% and impairs overall function. In the course of the disease, the joints are often operated on. During this operation, ruptures of the extensor tendons are found by chance without the patients noticing them. The aim of this retrospective study is the prevalence of extensor tendon rupture. Which tendon is destroyed most frequently? How can the functional outcome be measured after reconstruction? Materials and methods From 1572 operations on rheumatoid wrists, 61 extensor tendon ruptures were identified in 41 patients. The average time between the first rheumatic symptoms of the hand and surgery was 6.4 years. The average duration of RA was 7.8 years. 26 patients with 27 tendon reconstructions were included in the follow-up with an average postoperative duration of 4.6 years (3 to 14.2 years). Results Extensor tendons ruptures typically occurred at mechanically stressed sites. The most frequent rupture was found in the extensor pollicis longus tendon (21 tendons), followed by the small finger extensor tendon (14 tendons). A transfer was performed on 7 tendons. Fifty-five tendon lesions were sutured at other intact tendons. Free grafts were not used. The results in Clayton and QuickDASH scores were significantly different. Functional improvement was consistent with the results of tendon reconstructions in healthy control groups. Conclusion In rheumatoid patients, a rupture of an extensor tendon must be expected at 4%. Patients tolerate and compensate this damage for a long time. The function of the hand including the tendon function is the most important factor in assessing the success of the operation. The subjective patient acceptance depends on the progress of the underlying disease, postoperative care (ergotherapy, physiotherapy, orthosis) and the patients' demands.

DELINEATION OF EXTENSOR TENDON OF THE HAND BY MRI: USEFULNESS OF "SOAP-BUBBLE" MIP PROCESSING TECHNIQUE

Hand Surgery ◽  
2015 ◽  
Vol 20 (01) ◽  
pp. 93-98 ◽  
Author(s):  
Yumiko Tsujimoto ◽  
Koji Ryoke ◽  
Nobuo Yamagami ◽  
Yuji Uchio ◽  
Shigeko Tanaka
Keyword(s):  
Spin Echo ◽  
Maximum Intensity Projection ◽  
Extensor Tendon ◽  
Processing Technique ◽  
Water Suppression ◽  
Soap Bubble ◽  
Mri Findings ◽  
Extensor Pollicis Longus ◽  
Extensor Tendons ◽  
Suppression Technique

To evaluate the capability of the "Soap-Bubble" maximum intensity projection (MIP) processing technique in visualisation of extensor tendons of the hand, 36 intact subjects and seven patients with surgically confirmed extensor tendon rupture were examined. Three-dimensional T1-weighted turbo spin echo (3DT1TFE) MRI was performed using a sensitivity encoding flex coil, followed by Soap-Bubble MIP processing. For patients with extensor tendon ruptures, MRI findings and intraoperative findings were compared. As results, with only 3DT1TFE sequence, the entire extensor tendons that run along the arch of the hand were not shown on one image, but were visualised with addition of Soap-Bubble MIP. Although delineation of the extensor pollicis longus was poor in 27/43 subjects, it was much improved by the combination of water-suppression technique. MRI findings and intraoperative findings agreed in all patients. Soap-Bubble MIP processing with addition of water-suppression technique is considered useful for visualising the extensor tendons of the hand.

The tension band principle and angular testing of extensor tendon repairs

2011 ◽  
Vol 36 (4) ◽  
pp. 297-302 ◽  
Author(s):  
J. Henderson ◽  
M. Sutcliffe ◽  
P. Gillespie
Keyword(s):  
Extensor Tendon ◽  
Tension Band ◽  
Curved Surfaces ◽  
Full Extension ◽  
Testing Apparatus ◽  
Extensor Tendons

Extensor tendons in the finger are flat and not amenable to repair by core and epitendinous sutures. Mattress sutures and Kessler repairs without epitendinous stitching are often used for extensor tendon divisions in the fingers. Except when in full extension, the finger presents a series of curved surfaces (at each joint) to the tendon. It was hypothesized that extensor tendons are subject to the ‘tension band’ principle and that they might be amenable to repair by dorsal-only epitendinous sutures. A Silfverskiöld dorsal-only repair was compared with mattress and Kessler repairs in vitro on a curvilinear testing apparatus. The epitendinous technique was found to be significantly more resistant to gapping and rupture, as well as more resistant to deformation (i.e. stiffer) than the conventional techniques.

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