Two Potential Causes of EPL Rupture after Distal Radius Volar Plate Fixation

Benson, Eric C.; DeCarvalho, Alex; Mikola, Elizabeth A.; Veitch, John M.; Moneim, Moheb S.

doi:10.1097/01.blo.0000223998.02765.0d

Cited by 149 publications

(115 citation statements)

References 14 publications

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“…Al-Rashid et al [31] reported an incidence of extensor tendon rupture of 8.6 % of 35 cases (three cases) treated with an AO volar locking plate, citing screw penetration of the dorsal cortex and careless drilling technique as principle causes. Other authors reporting extensor tendon irritation and ruptures have cited similar reasons [32][33][34][35]. It is worth noting that extensor tendon injury has also been reported in 5 % of undisplaced distal radius fractures, most likely due to extensor irritation over dorsal callus formation [36].…”

Section: Discussionmentioning

confidence: 91%

Functional Outcome and Complications at 2.5 Years Following Volar Locking Plate Fixation of Distal Radius Fractures

et al. 2016

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Distal radius fractures are increasingly treated by internal fixation, but there have been relatively few studies relating to functional outcome at 12 months or more. The aim of this study was to ascertain the patient reported function of the wrist at a minimum of 12 months following fixation of a distal radius fracture, the time taken to return to work, and the complication rate. We conducted a retrospective review of 187 consecutive patients treated by a specialist hand and wrist trauma team at a tertiary referral unit over a 5 year period. Mean age was 57.3 years (range 16-93). Median time to surgery was 4 days (interquartile range 2-9). Median follow up was 31 months (interquartile range 23-41 months). The median PRWE score was 3; (range 0-83). There was no difference in outcome in patients who had surgery delayed by greater than 2 weeks (p>0.05). The median time to return to work was 5 weeks (interquartile range 1-8 weeks). There were 15 complications (8 %) including 3 tendon injuries. We have demonstrated an early return to work in patients who were employed, a low complication rate, and highly favourable functional outcomes at a mean of 30 months postoperatively. We recommend the use of the DVR plate and involvement of a dedicated hand and wrist trauma team for treatment of unstable fractures of the distal radius.

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Section: Discussionmentioning

confidence: 91%

Functional Outcome and Complications at 2.5 Years Following Volar Locking Plate Fixation of Distal Radius Fractures

et al. 2016

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“…Although volar plates are usually well tolerated, they can lead to impingement on the extensor tendons when the fixation screws are too long and extend beyond the dorsal cortex of the radius. This form of impingement has been reported in several articles in the orthopedics literature [8][9][10][11][12], but we are unaware of similar studies in the radiology literature.…”

Section: Sonography Of Screw Impingement On Extensor Tendons After Vomentioning

confidence: 89%

“…All were treated with Kirschner-wire fixation and not with volar plating [8]. Although the authors of several articles in the orthopedics literature have described extensor tendon tears caused by protruding screws [9][10][11][12], in none was sonography used preoperatively.…”

Section: Sonography Of Screw Impingement On Extensor Tendons After Vomentioning

confidence: 99%

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

Bianchi

Aaken²,

Glauser³

et al. 2008

American Journal of Roentgenology

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W199age, 54 years). Three right wrists and six left wrists were affected. Four patients were referred with a presumptive diagnosis of complete extensor pollicis longus (EPL) tear and three had a diagnosis of tenosynovitis; one, a dorsal mass; and one, a ganglion cyst. Patients presented with local pain (n = 8), swelling (n = 7), and inability to extend the distal phalanx of the thumb (n = 4). Informed consent was obtained to search patients' data retrospectively. Institutional review board approval was obtained.All sonography examinations were performed by a trained musculoskeletal radiologist with 22 years of experience in musculoskeletal sonography. The mean delay between surgery and sonography examination was 7 months (range, 1-27 months). The dorsal aspect of the wrist was examined on transverse and sagittal sonograms obtained while the patient was seated in front of the examiner with the pronated wrist resting on an examination table. All 12 extensor tendons, running inside the six compartments, were carefully analyzed (Fig. 1). A broadband 17-5-MHz linear transducer (model iU22, Philips Healthcare) was used. No standoff pad was used, and transmission gel was used liberally. Attention was directed to looking for changes in the internal structure of the extensor tendons, thickening of the tendons' sheaths, and evidence of synovial effusions. The presence or absence of tendon tears was noted. We also evaluated focal interruption of the dorsal cortex of the distal radius, the number and location of detectable screw tips, and the length that each screw tip protruded using electronic calipers. In M u s c u l o s ke l e t a l I m ag i ng • C l i n ic a l O b s e r v a t io n ractures of the distal radius are frequent and their incidence can be expected to increase because the older population continues to increase in number [1]. Surgical treatment allows optimal fragment reduction and is advocated when a significant dorsal tilt is present or fractures are unstable. The most commonly performed surgical procedure is open reduction and internal fixation of the volar plate [1,2]. Tendon inflammation and tears are possible complications of that procedure due to dorsally protruding screw impingement on the extensor tendons. Sonography is a readily available and atraumatic imaging technique that allows accurate and inexpensive assessment of the musculoskeletal system [3]. The extensor tendons of the wrist are well depicted by high-resolution broadband electronic transducers because of their superficial location [3,4]. We present a retrospective analysis of the sonography examinations of nine consecutive patients presenting with screw impingement on the extensor tendons examined in the past 3.5 years. ObjeCtIve. The objective of our study was to analyze the sonography examinations of nine consecutive patients with a history of distal radius fracture treated by open reduction and internal fixation of the volar plate who were referred by hand surgeons for sonography of the dorsal aspect of the wrist. Screw Impingement o...

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“…This complication is thought to be avoidable. When volar locking plates are used, properly locating the plates and an adequate screw length are important to avoid tendon problems [2,5,13]. In the computer system, we can simulate the best location for the plates and calculate the best screw length.…”

Section: Discussionmentioning

confidence: 99%

Distal Radius Osteotomy with Volar Locking Plates Based on Computer Simulation

Miyake

Murase

Moritomo

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Corrective osteotomy using dorsal plates and structural bone graft usually has been used for treating symptomatic distal radius malunions. However, the procedure is technically demanding and requires an extensive dorsal approach. Residual deformity is a relatively frequent complication of this technique. Questions/purposes We evaluated the clinical applicability of a three-dimensional osteotomy using computeraided design and manufacturing techniques with volar locking plates for distal radius malunions. Patients and Methods Ten patients with metaphyseal radius malunions were treated. Corrective osteotomy was simulated with the help of three-dimensional bone surface models created using CT data. We simulated the most appropriate screw holes in the deformed radius using computer-aided design data of a locking plate. During surgery, using a custom-made surgical template, we predrilled the screw holes as simulated. After osteotomy, plate fixation using predrilled screw holes enabled automatic reduction of the distal radial fragment. Autogenous iliac cancellous bone was grafted after plate fixation. Results The median volar tilt, radial inclination, and ulnar variance improved from À20°, 13°, and 6 mm, respectively, before surgery to 12°, 24°, and 1 mm, respectively, after surgery. The median wrist flexion improved from 33°b efore surgery to 60°after surgery. The median wrist extension was 70°before surgery and 65°after surgery. All patients experienced wrist pain before surgery, which disappeared or decreased after surgery. Conclusions Surgeons can operate precisely and easily using this advanced technique. It is a new treatment option for malunion of distal radius fractures.

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Two Potential Causes of EPL Rupture after Distal Radius Volar Plate Fixation

Cited by 149 publications

References 14 publications

Functional Outcome and Complications at 2.5 Years Following Volar Locking Plate Fixation of Distal Radius Fractures

Functional Outcome and Complications at 2.5 Years Following Volar Locking Plate Fixation of Distal Radius Fractures

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

Distal Radius Osteotomy with Volar Locking Plates Based on Computer Simulation

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