Tendon Entrapment in Distal Radius Fractures

2009 ◽  
Vol 34 (4) ◽  
pp. 479-482 ◽  
Author(s):  
M. OKAZAKI ◽  
K. TAZAKI ◽  
T. NAKAMURA ◽  
Y. TOYAMA ◽  
K. SATO
Keyword(s):  
Clinical Features ◽  
Distal Radius ◽  
Flexor Tendon ◽  
Extensor Tendon ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Extensor Tendons ◽  
Epiphyseal Fracture ◽  
Tendon Entrapment

We retrospectively defined the rate and clinical features of tendon entrapment in 693 consecutive patients with 701 distal radius fractures treated in a single hospital. Eight extensor tendons and one flexor tendon were entrapped. All fractures with extensor tendon entrapment were palmarly displaced (Smith type) or epiphyseal. Flexor tendon entrapment was seen in dorsally angulated (Colles type) epiphyseal fracture. The rate of tendon entrapment in acute distal radius fractures was 1.3%. Extensor tendon entrapment in palmarly displaced fractures is more common.

scholarly journals Extensor Tendon Entrapment on Computed Tomography Imaging of Distal Radius Fractures

2019 ◽  
Vol 09 (02) ◽  
pp. 129-135
Author(s):  
Evan D. Nigh ◽  
Christopher P. Emerson ◽  
David To ◽  
Spencer Barnhill ◽  
Michael G. Rizzo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Distal Radius ◽  
Motor Vehicle ◽  
Ct Imaging ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Distal Radial Fractures ◽  
Level Of Evidence ◽  
Extensor Pollicis Longus ◽  
Tendon Entrapment

Abstract Objective To examine the association between distal radius fractures and tendon entrapment identified on computed tomography (CT) imaging. Patients and Methods After Institutional Review Board approval, we retrospectively reviewed distal radius fractures that underwent CT imaging from an electronic database between January 2006 to February 2018 at a single level 1 hospital trauma center. We categorized all distal radial fractures according to the AO-OTA (AO Foundation/Orthopaedic Trauma Association) classification. Distal upper extremity tendons were assessed for entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. Results A total of 183 distal radius fractures were identified in 179 patients. A total of 16 fractures (13 males and 3 females) were associated with tendon entrapment. Mechanism of injury included falls (n = 7), motor vehicle accidents (n = 6), dog bites (n = 2), and gunshot wound (n = 1). Entrapped tendons were limited to the extensor compartment and included the extensor pollicis longus (EPL; n = 11), extensor pollicis brevis (n = 1), extensor carpi ulnaris (n = 1), extensor carpi radialis longus (n = 1), and extensor digitorum communis (n = 2). The most commonly associated AO-OTA fracture pattern with tendon entrapment was complete articular radial fractures (2R3C; 69%), eight of which were simple articular with metaphyseal multifragmentary fractures (2R3C2). Of the distal radius fractures, 81% were associated with additional ulnar fractures of varying severity and displacement. Conclusion Approximately 8.7% of distal radius fractures were retrospectively identified to have tendon entrapment compared with a previously reported incidence of 1.3%. Wrist surgeons and radiologists should have higher suspicion for tendon entrapment and carefully review preoperative CT imaging for tendon entrapment in distal radius fractures especially if there is an intra-articular, multifragmentary injury pattern. Wrist surgeons and radiologists should also have increased suspicion for EPL tendon entrapments given its high incidence in association with distal radius fractures. Level of Evidence This is a Level III, retrospective cross-sectional study.

scholarly journals Screw Impingement on the Extensor Tendons in Distal Radius Fractures Treated by Volar Plating: Sonographic Appearance

2008 ◽  
Vol 191 (5) ◽  
pp. W199-W203 ◽  
Author(s):  
Stefano Bianchi ◽  
Jan van Aaken ◽  
Thierry Glauser ◽  
Carlo Martinoli ◽  
Jean-Yves Beaulieu ◽  
...  
Keyword(s):  
Distal Radius ◽  
Distal Radius Fractures ◽  
Volar Plating ◽  
Radius Fractures ◽  
Sonographic Appearance ◽  
Extensor Tendons

Pearls and Pitfalls of the Volar Locking Plating for Distal Radius Fractures

2016 ◽  
Vol 21 (02) ◽  
pp. 125-132 ◽  
Author(s):  
Jin-Hyung Im ◽  
Joo-Yup Lee
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Plate Fixation ◽  
Extensor Tendon ◽  
Distal Radius Fractures ◽  
Fixation Strength ◽  
Volar Locking Plate ◽  
Radius Fractures ◽  
Locking Plate Fixation ◽  
Distal Locking

Volar locking plate fixation has been widely accepted method for the treatment of unstable distal radius fractures. Although the results of volar locking plate fixation are encouraging, it may cause implant-related complications such as flexor or extensor tendon injuries. In depth understanding of anatomy of the distal radius is mandatory in order to obtain adequate fixation of the fracture fragments and to avoid these complications. This article will review the anatomic characteristics of the distal radius because selecting proper implant and positioning of the plate is closely related to the volar surface anatomy of the distal radius. The number and the length of distal locking screws are also important to provide adequate fixation strength to maintain fracture fixation. We will discuss the pros and cons of the variable-angle locking plate, which was introduced in an effort to provide surgeons with more freedom for fixation. Finally, we will discuss about correcting radial length and volar tilt by using eccentric drill holes and distal locking first technique.

scholarly journals Acute Isolated Flexor Tendon Laceration Associated With a Distal Radius Fracture

Hand ◽  
2016 ◽  
Vol 12 (3) ◽  
pp. NP39-NP42 ◽  
Author(s):  
J. Ryan Hill ◽  
Ram K. Alluri ◽  
Alidad Ghiassi
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Tendon Rupture ◽  
Flexor Tendon ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Flexor Tendon Rupture ◽  
Tendon Laceration

Background: Subacute rupture of the flexor tendons secondary to distal radius fractures is well documented. Recently, accounts of flexor tendon rupture following open reduction internal fixation have been associated with volar plate fixation. However, discovery of an occult traumatic flexor tendon laceration during fixation of an acute distal radius fracture is not well described. This case indicates the importance of careful preoperative and intraoperative examination of the flexor tendons in the setting of comminuted distal radius fractures. Methods: A forty-seven-year-old male sustained a comminuted, dorsally displaced distal radius fracture. Initial and post-reduction examinations revealed no gross functional abnormalities. Upon operative fixation of the fracture, laceration of the flexor digitorum profundus (FDP) tendon to the index finger was incidentally noted at the level of the fracture site. Results: Due to extensive dorsal comminution, shortening, and the presence of a lunate facet fragment, we performed volar fragment-specific and dorsal spanning bridge plate fixation. The proximal and distal ends of the FDP tendon were marked, but repair was deferred until implant removal. This allowed for proper informed consent and avoided potential compromise of the repair given the presence of a volar implant. Conclusions: Acute flexor tendon rupture secondary to closed distal radius fractures may go unnoticed if a high index of suspicion is not maintained. Delayed diagnosis of these ruptures convolutes the mechanism of injury and disrupts the recovery process. Hand surgeons should be vigilant in examining flexor tendon function during the preoperative evaluation, especially in the setting of acute high-energy injury.

scholarly journals Flexor tendon complications in comminuted distal radius fractures treated with anatomic volar rim locking plates

2016 ◽  
Vol 50 (6) ◽  
pp. 665-669 ◽  
Author(s):  
Adnan Kara ◽  
Haluk Celik ◽  
Yunus Oc ◽  
Metin Uzun ◽  
Mehmet Erdil ◽  
...  
Keyword(s):  
Distal Radius ◽  
Flexor Tendon ◽  
Distal Radius Fractures ◽  
Locking Plates ◽  
Radius Fractures

scholarly journals Functional Outcomes Following Fixation of an Ultra-distal Radius Fracture with Two Commonly used Volar Locking Plates: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Yin-Ming Huang ◽  
Chun-Yu Chen ◽  
Kai-Cheng Lin ◽  
Yih-Wen Tarng ◽  
Ching-Yi Liao ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Functional Outcomes ◽  
Flexor Tendon ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Mayo Wrist Score ◽  
Patient Reported

Abstract Introduction: The volar locking plate has been widely used for unstable distal radius fractures to provide early recovery of wrist function. Volar plate prominence to the watershed line has been reported to be related to flexor tendon irritation, and avoid implant prominence in this area was suggested. On the other hand, ultra-distal radius fracture patterns required the plate to cross the watershed line, making conflict over plate positioning on ultra-distal radius fractures. This study compared functional outcomes in patients with ultra-distal radius fractures treated with two different implants.Materials and Methods: A retrospective study was conducted, all patients who received a Synthes 2.4mm LCP or an Acumed Acu-Loc VLP between January 2015 and December 2018 were reviewed. The ultra-distal fracture pattern was the most distal horizontal fracture line within 10 mm of the lunate fossa's joint line. The primary outcomes including patient-reported pain scores, range of motion, and grip strength were assessed. Secondary outcomes included patient-based subjective satisfaction scores of the injured wrist and hand function. The Mayo Wrist Score and the requirement for a secondary procedure related to hardware complications were also recorded. Results: Forty-two patients met our inclusion criteria. Twenty-one patients were treated with the Synthes 2.4 mm LCP, and 21 patients with the Acumed Acu-Loc VLP. The primary outcome revealed that post-operative range of motion (P = 0.016) and gripping strengths (P = 0.014) were significantly improved in the Acu-Loc VLP group. The MAYO wrist score in the Acu-Loc VLP group was also significantly better (P = 0.006). Conclusions: Despite advances in implant designs, flexor tendon irritation or rupture is still a complication following distal radius's volar plating. We believe the Acumed Acu-Loc VLP design provided better functional outcomes than the Synthes 2.4 mm LCP if appropriately and carefully placed into its designed-for position. This positioning results in promising patient satisfaction when treating ultra-distal radius fractures.

Operative Treatment of Distal Radius Fractures

2008 ◽  
Vol 97 (4) ◽  
pp. 290-296 ◽  
Author(s):  
J. Vasenius
Keyword(s):  
Distal Radius ◽  
Extensor Tendon ◽  
Distal Radius Fractures ◽  
Fixation Method ◽  
Complication Rates ◽  
Radius Fractures ◽  
Articular Fractures ◽  
Radiocarpal Joint ◽  
Median Nerve Neuropathy ◽  
Dorsal Plating

The incidence of distal radius fractures is increasing together with the average age of population. Intra-articular incongruity is the most probable cause of unsatisfactory outcome of distal radius fractures in younger and more active patients. Thus, the main goal in the treatment of distal radius fractures should be restoration of articular congruence. A computed tomography (CT) is recommended to help surgeon in preoperative planning in the treatment of comminuted intra-articular fractures. New implants have been designed to provide stable enough fixation for early mobilisation after surgery and to lower rather high complication rates related to conventional fixation methods such as external fixation and dorsal plating. The most common complications related to volar fixed angle plating such as flexor and extensor tendon problems, median nerve neuropathy, and screw diplacement into the radiocarpal joint are surgeon related and are avoidable with proper education. More randomized prospective studies are needed to prove superiority of any fixation method to another.

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