Rupture of the extensor pollicis longus tendon can occur after volar plate fixation of dorsally comminuted distal radius fractures. We attempted to identify the etiology of extensor pollicis longus tendon injury after volar plate fixation of the distal radius and potential solutions to this problem. After describing two case reports, we examine six cadaveric specimens and retrospectively review 10 selected patients to evaluate possible technique refinements to minimize damage to the extensor pollicis longus tendon during volar plating of the distal radius. We identify specific screw holes in three commercially available volar distal radius plates that direct the drill bit or prominent screw tips into the third extensor compartment. In addition, after reduction and plate fixation, bone fragments or dorsal gapping may predispose the extensor pollicis longus tendon to injury. We recommend either using shorter screw lengths or leaving the implicated plate holes unfilled. In addition, we suggest consideration of an open assessment of the third extensor compartment, if indicated, as performed through a small dorsal incision ulnar to Lister's tubercle.

No abstract

The incidence of SCFE has increased dramatically in New Mexico since Kelsey's epidemiological study in 1970. Obesity is a patient factor that has changed over this same period. According to the National Health and Nutrition Examination Survey Data for 2003/2004, the rates of obesity have tripled since 1971. In New Mexico, 25% of high-school children are estimated to be overweight. However, according to a recent study examining a national database (compiled from 27 states), the national incidence of SCFE remained fairly constant at 10.8 per 100,000.Interestingly, as more patients are seen at a tertiary center for children's orthopaedics, the rate of diagnosis in New Mexico has risen to resemble national trends. In the 1960, that center was located in a remote site and did not provide acute care for children's musculoskeletal issues. Increased obesity in children and improved access to pediatric orthopaedic evaluation may have contributed to a significant increase in reported incidence of SCFE in New Mexico.