Haemoperitoneum following gunshot wound of the thigh

Abstract

We have reported here the case of a rupture of the extensor pollicis longus caused by the protruding end of a screw which was too long placed through a volarly situated plate to stabilize a Barton’s fracture. On the lateral radiograph of our patient’s wrist, it can be seen that the screw inserted through the oval hole of the buttress plate protrudes beyond the far cortex by two turns (Figure~b). This screw is usually inserted first to obtain temporary fixation of the plate to the volar aspect of the distal radius. The plate can then be slid distally or proximally to obtain optimum buttressing of the volarly displaced fragment of a Barton’s fracture. Insertion of further plate screws approximate the plate to the bone, thereby decreasing the distance from the plate to the drilled far cortex. When all screws have been inserted, it is therefore necessary to remove the initial screw, to repeat measurement of the length of the screw hole and insert a shorter screw. This step was most probably omitted in the case described here; instead, as the screw in the oval hole was tightened after insertion of other screws, it came to protrude beyond the far cortex where it produced a delayed attrition rupture of the extensor pollicis longus. References