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DOI: 10.1055/a-0826-4731
Extensor pollicis longus tendon rupture caused by a displaced dorsal “beak” fragment of Lister’s tubercle in distal radius fractures
Ruptur der Extensor pollicis longus-Sehne bei dislozierter Fraktur des Lister’schen Tuberkulums bei distaler RadiusfrakturPublication History
21 October 2018
14 December 2018
Publication Date:
08 May 2019 (online)
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Abstract
Introduction Ruptures of the extensor pollicis longus (EPL) tendon are a well-known complication of distal radius fractures (DRF). There are a lot of suspected mechanisms, including mechanical friction, vascular impairment, injury associated with reduction, and local adhesion. However, there have been limited reports about a closed rupture of the EPL tendon associated with a relatively large, displaced dorsal “beak” fracture fragment. We report about the management outcomes and clinical significance of closed ruptures of the EPL tendon caused by a displaced dorsal fracture fragment of beak-like appearance in DRF.
Patients/Material and Methods Our study included 7 cases of a complete closed rupture of the EPL tendon after open reduction internal fixation. All cases showed a similar pattern involving a relatively large dorsal beak fragment originating from Lister’s tubercle, and we treated them with a palmar locking plate within 7 days from the initial fracture without separate dorsal fragment management. All patients were diagnosed with a delayed EPL tendon rupture.
Results The study included 5 female and 2 male patients. Mean patient age was 59 years. In all cases we explored the extensor compartment III to verify the exact cause of the EPL rupture. Six patients underwent an extensor indicis transfer and one patient underwent tendon grafting.
Mean fragment width and length were 7.0 mm and 13.3 mm, respectively. The fragments were dorsally elevated (mean, 2.4 mm) and distally displaced (mean, 3.5 mm). At the last follow-up, the mean DASH score was 4.4. Mean thumb MP joint flexion and extension were 4 degrees and 62 degrees, respectively.
Conclusion We support the possibility of EPL tendon rupture caused by displaced sharp Lister’s tubercle fracture fragments.
Zusammenfassung
Hintergrund Die Ruptur der Sehne des M. extensor pollicis longus (EPL) ist eine bekannte Komplikation distaler Radiusfrakturen. Bzgl. der Ursache gibt es etliche Vermutungen, angefangen von mechanischen Irritationen der Sehne, über Beeinträchtigung ihrer Durchblutung und Verletzungen der Sehne im Rahmen der Reposition, bis hin zu lokalen Verklebungen. Wenig wurde bisher berichtet über EPL-Rupturen durch ein disloziertes, relativ großes, „schnabelartig“ aussehendes Fragment des Lister’schen Tuberkulums.
Ziel Wir berichten über EPL-Rupturen bei distalen Radiusfrakturen durch ein disloziertes Fragment des Lister’schen Tuberkulums, ihre Behandlung und Ergebnisse.
Patienten und Methoden Bei 7 Patienten, 5 Männern und 2 Frauen mit einem Durchschnittsalter von 59 Jahren, mit distaler Radiusfraktur, versorgt innerhalb von 7 Tagen nach dem Unfall mit einer palmaren winkelstabilen Platte, wurden sekundäre EPL-Rupturen, verursacht durch ein relativ großes, „schnabelartiges“ Fragment des Lister’schen Tuberkulums, das primär nicht angegangen wurde, beobachtet. In allen Fällen erfolgte die operative Revision unter Inspektion des 3. Strecksehnenfaches und Dokumentation des Befundes.
Ergebnisse In allen Fällen fand sich ein Knochensporn mit einer durchschnittlichen Länge und Breite von 13,3 mm mal 7,0 mm als Ursache für die EPL-Ruptur mit einer Dislokation nach distal im Mittel von 3,5 mm und nach dorsal um 2,4 mm. Bei 6 der Patienten erfolgte ein Extensor indicis-Transfer, einmal eine Sehneninterposition. Bei der letzten Nachuntersuchung lag der DASH-Score bei 4,4 Punkten, die durchschnittliche Daumengrundgliedextension/flexion betrug 62–0–4 Grad.
Schlussfolgerung Insbesondere größere, dislozierte Fragmente des Lister’schen Tuberkulums können zu sekundären EPL-Rupturen führen und bedürfen bei der Versorgung distaler Radiusfrakturen von der Beugeseite der Beachtung.
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