Extensor pollicis longus tendon rupture caused by a displaced dorsal “beak” fragment of Lister’s tubercle in distal radius fractures

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.

Rotura del extensor pollicis longus en paciente pediátrico: reporte de caso y revisión de la literatura

“…En 1876, Duplay publica el primer caso de ruptura espontánea de EPL 4 y desde entonces son numerosos los casos similares descritos, observando que la mayoría se producen en adultos tras 6-7 semanas desde la fractura de radio distal. 2,5,6,7,8 El presente caso clínico expuesto aquí destaca por la baja frecuencia de este de cuadro clínico en pacientes pediátricos y constituye una singularidad al tratarse de uno de los pacientes más jóvenes (13 años) reportado hasta la fecha.…”

“…La fisiopatología de la lesión es multifactorial; por un lado, de tipo mecánico como es el desgaste producido por el rozamiento en el tubérculo de Lister, por un reborde óseo resultado de una fractura desplazado, 8 o bien, causas iatrogénicas como el uso de clavos elásticos de titanio, la fijación con placa volar o dorsal. 9 Por otro lado, existen otras causas menos frecuentes, tales como falta de riego sanguíneo en fracturas no desplazadas, 10 lesiones traumáticas directas, patologías sistémicas como la artritis reumatoide 11 o el lupus 12 y uso de corticoesteroides tanto locales como sistémicos.…”

Intraartikuläre Frakturen des distalen Radius – Teil 2

“…Grund hierfür ist die mit der Palmarinklination der Radiusgelenkfläche einhergehende Druck-/Kraftübertragung von der Handwurzel auf den Radius in der palmaren Hälfte der Radiusgelenkfläche. Da Dislokationen des Listerschen Tuberkulums nach distal mit einer erhöhten Gefahr der Ruptur der Sehne des Extensor pollicis longus (EPL) [10] und selten auch anderer Strecksehnen (▶ Abb. 1) einhergehen, empfiehlt sich die Resektion oder Refixation.…”

Spontaneous rupture of extensor pollicis longus after distal radius fracture: a case report

“…4 Nevertheless, debates persist regarding the definitive mechanism. 5 Most cases manifest 4 to 8 weeks after the traumatic event. 3 Patients commonly report pain and tenderness at the wrist, with some describing a distinct "ping" sensation at the time of rupture.…”