Incidence Of Tendon Rupture Research Articles

The relationship between plate prominence and need for removal after volar plate osteosynthesis of distal radius fractures.

This study aimed to assess the incidence of plate-related complications and the need for plate removal after volar plate osteosynthesis of the distal radius in relation to Soong classification. All consecutive patients (age > 16years) in our level II trauma center treated with plate osteosynthesis for distal radius fractures from January 2017 until June 2019 were retrospectively evaluated. The main outcome measures were volar plate positioning according to Soong classification and incidence of plate removal. In addition, the incidence of tendon ruptures, reasons for volar plate removal, and improvement of complaints after removal were evaluated. The overall incidence of plate removal in the 336 included patients was 16.9% (n = 57). Removal incidence in Soong 2 plates (28.2%) was significantly higher compared to Soong 0 and 1 plates (8.0% and 14.4%, respectively), P = 0.003. Multivariable binary logistic regression analysis showed Soong grade 2 as an independent predictor for plate removal, OR 4.3 (95% CI 1.4-13.7, P = 0.013). Four cases of flexor and four cases of extensor tendon rupture were reported, all in Soong 2 grade plating. The main reasons for volar plate removal were pain (42%) and reduced functionality (12%). In cases where pain was the main reason for removal, 81% of patients reported a decrease in pain during follow-up after surgery. This study suggests an association between plate prominence graded by Soong and plate removal using a single plating system. Plate prominence should be reduced in volar plating whenever technically feasible.

Poster 375: Incidence of Tendon Ruptures in the US: Comparison of Differences Across Racial Groups

Poster 375: Incidence of Tendon Ruptures in the US: Comparison of Differences Across Racial Groups

Incidence of Tendon Rupture After Collagenase Clostridium Histolyticum Injection for Treatment of Dupuytren Contracture in Adults: A Postmarketing Safety Analysis

Based, in part, on the clinical study reports of tendon rupture events after collagenase clostridium histolyticum (CCH) (Xiaflex, Endo Pharmaceuticals Inc) treatment for Dupuytren contracture (DC), a Risk Evaluation and Mitigation Strategy program was instituted in 2010 by Auxilium Pharmaceuticals (now Endo Pharmaceuticals Inc) to ensure that the benefits of CCH injection outweighed the risks when treating DC. Using the postmarketing surveillance data collected in this program, a retrospective analysis was conducted to evaluate the incidence of flexor tendon rupture after CCH treatment for DC in the clinical practice setting. The Endo Pharmaceuticals Inc safety database was searched for cases of tendon rupture reported between February 2, 2010, and October 8, 2015. Total number of CCH treatments for DC and incidence of tendon rupture were estimated using CCH dosing derived from clinical trial experience (1.7 CCH vials/treatment) or clinical practice evidence (1.08 CCH vials/treatment). Over the 5.8-year surveillance period, 97,609 vials of CCH were distributed for the treatment of DC, equivalent to an estimated total of 57,416 treatments (at 1.7 CCH vials/treatment) or 90,378 treatments (at 1.08 CCH vials/treatment). Although CCH distribution increased during the surveillance period, reports of tendon rupture were infrequent (approximately 13 cases/y; total cases: flexor tendon, n = 57; ligament/pulley, n = 2), corresponding to a 0.10% (1.7 CCH vials/treatment) or 0.06% (1.08 CCH vials/treatment) mean estimated incidence of tendon rupture in patients with DC after CCH treatment. This retrospective analysis showed that flexor tendon rupture occurred infrequently in patients with DC who were treated with CCH in real-world practice settings between 2010 and 2015. On the basis of these findings and other favorable safety evidence, the Risk Evaluation and Mitigation Strategy program requirement for CCH for the treatment of DC was ended by the US Food and Drug Administration in November2016. Therapeutic IV.

Implant prominence and flexor tendon rupture in distal radial fractures using volar locking plate technology: a retrospective chart review

Background: Volar locking plate (VLP) fixation, an accepted treatment for distal radial fractures, has the known complication of flexor tendon rupture, theorized to be caused by implant positioning. Although implant position is a suspected risk factor, incidence of tendon rupture may be less than previously reported. This study investigated implant prominence and its relation to tendon rupture. Methods: Surgical records of 197 patients who underwent repair of distal radial fractures using VLP fixation between July 2014 and December 2017 were retrospectively reviewed. Pre- and postoperative radiographs were used to assign AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification and implant prominence using the Soong classification. Chi square and Fisher’s Exact Tests compared Soong groups to fracture classification, hand function, and reoperation. A phone survey was used to determine finger function. Results: Eleven patients underwent reoperation, six for tendon irritation with no tendon ruptures. Fracture classification (P=0.601) and Soong grade (P=0.687) showed no difference when compared with reoperation. There was a difference (P=0.039) comparing fracture classification to Soong classification, with higher fracture classification associated with higher Soong classification. No difference (P>0.05) for finger function was found between either group. Conclusions: Flexor tendon rupture historically has been linked to VLP fixation in distal radial fractures. This study found tendon rupture was not associated with fracture classification or implant prominence and had a lower incidence than previously reported. Finger function had no relation to fracture classification or implant prominence. This study suggested implant prominence is more likely with increasing fracture complexity with little clinical significance. Level of Evidence: Level IV

Incidence of tendon ruptures after locking plate fixation of distal radial fractures: are the cited rates still accurate?

With the introduction of the anterior locking plate in the early part of this century, there was a large change in how distal radial fractures were treated. Early articles about the techniques reported tendon ruptures occurring in as many as 10%, although studies from our unit reported rates closer to 2%. Subsequent refinements in surgical technique and improvements in plate design have been made with the aim of reducing the number of ruptures. Despite this, the original articles and their rates continue to be quoted. In this retrospective study of 798 cases treated with anterior locking plates, tendon ruptures have been significantly reduced and are now as low as 0.5%. Contributing factors leading to this improvement are identified and discussed.Level of evidence: III.

Incidence of Complications following Volar Locking Plate Fixation of Distal Radius Fractures: An Analysis of 647 Cases.

This study assessed the risk and factors of complications after volar locking plate fixation of distal radius fractures. A single-institution retrospective review of patients undergoing volar locking plate fixation of distal radius fractures between May of 2000 and May of 2015 was undertaken. Demographic data, major complications, minor complications, and radiographic parameters were evaluated. Six hundred forty-seven distal radius fractures managed with volar plate fixation in 636 patients were reviewed. Mean follow-up was 9.1 months. Mean age was 56.5 years. Mean body mass index was 28.0, and 14.6 percent of patients had a body mass index greater than 35. Fractures were classified as Arbeitsgemeinschaft für Osteosynthesefragen class 23-C (67.2 percent), 23-A (26.6 percent), and 23-B (6.2 percent). The incidence of major and minor complications was 13.8 percent and 17.5 percent, respectively. The most common complication was transient paresthesia (9.7 percent). The incidence of tendon rupture or irritation was 0.5 percent or 2.5 percent, respectively. Hardware removal for painful/symptomatic hardware occurred in 6.2 percent at an average of 427.8 days after surgery. Major complications and minor complications were increased 2.2- and 1.9-fold, respectively, in patients with a body mass index greater than 35. Major complications were also increased 3.19 times in patients with residual intraarticular step-off. Hardware removal was 3.3 times more likely in patients with Soong grade 2 plate prominence and 2.9 times more likely in patients with a history of diabetes mellitus. Volar plate osteosynthesis of distal radius fractures is associated with an overall low complication rate. Patient factors, including diabetes mellitus and obesity, and intraoperative factors, including intraarticular fracture alignment and plate prominence, were associated with a higher rate of complications or revision surgery. Risk, III.

Tendon Rupture and Tenosynovitis following Internal Fixation of Distal Radius Fractures: A Systematic Review

Tendon-related complications after plate fixation of distal radius fractures can cause significant morbidity in the patient. This retrospective systematic review aims to report and compare the current rate of tendon rupture and tenosynovitis complicating the operative management of distal radius fractures. A systematic literature search was performed to identify relevant articles reporting tendon complications after operative management of distal radius fractures. The search included published articles in three electronic databases-Ovid MEDLINE, EMBASE, and the Cochrane Library-starting from the establishment of each database to February of 2016. A total of 56 studies met the inclusion criteria, including 6278 patients. Overall tendon-related adverse events were reported in 420 patients (6.8 percent). The incidence of tendon rupture was 1.5 percent with volar plates and 1.7 percent with dorsal plates. The incidence of tenosynovitis was 4.5 percent with volar plates and 7.5 percent with dorsal plates. Individual tendon complications were reported with volar and dorsal fixation, respectively: extensor pollicis longus tenosynovitis (0.3 percent and 1.1 percent), extensor pollicis longus rupture (0.8 percent and 0.3 percent), flexor pollicis longus tenosynovitis (1.3 percent and 0 percent), flexor pollicis longus rupture (0.6 percent and 0.2 percent), flexor digitorum profundus/flexor digitorum superficialis tenosynovitis (1.2 percent and 1.3 percent), flexor digitorum profundus/flexor digitorum superficialis rupture (0.1 percent and 0 percent), extensor digitorum communis tenosynovitis (1.7 percent and 5.9 percent), and extensor digitorum communis rupture (0.05 percent and 1.3 percent). This systematic review provides an update on the literature regarding tendon-related complications in the management of distal radius fractures.

Tendon Rupture After Volar Locking Plate Fixation of Distal Radius Fractures

Background: The volar locking plate (VLP) has been widely used over the past 2 decades in patients with distal radius fractures (DRFs). However, flexor pollicis longus (FPL) ruptures are a well-known postoperative complication of using the VLP system, although the incidence of tendon ruptures following VLP fixation remains unclear. The purpose of the present study was to assess the frequency of FPL rupture on a large scale in patients with DRFs who were treated with the VLP system. Materials and Methods: A questionnaire was administered by an orthopedic surgeon who performed the surgeries in patients with DRFs in our prefecture. Thirty institutions were enrolled in this study. The questionnaire consisted of 2 parts. The first part comprised the number of patients who underwent surgery using the VLP and the number of patients who suffered a tendon rupture between January 2011 and December 2014. The second part comprised the surgeon’s policy for removing the implant after bone union was achieved. Results: All 30 institutions responded to the first part of the questionnaire, and 50 orthopedic surgeons who were working at the institutions answered the second part of the questionnaire. During the 4-year period, 2787 patients with DRFs underwent fixation using a VLP. The overall incidence of FPL rupture, extensor pollicis longus rupture, flexor digitorum profundus (index finger) rupture, and extensor digitorum communis rupture was 0.35% (10/2787), 0.29% (8/2787), 0.04% (1/2787), and 0.04% (1/2787), respectively. Regarding the question about implant removal, 18 surgeons responded that they removed the implant in almost all cases, 25 answered that they removed the implant depending on the case, and 7 responded that they usually do not remove the implant. Conclusion: This study evaluated 2787 patients with DRFs who underwent fixation using a VLP. FPL rupture occurred in 10 patients (0.35%), whereas other tendon ruptures occurred less often. Implant removal was performed by more surgeons in our prefecture.

Can Relative Motion Extension Splinting Provide Earlier Return to Hand Function Than a Controlled Active Motion Protocol? A Randomized Clinical Trial

Objective: Various active mobilization protocols are used after repair of extensor tendons in zone V and VI. These include relative motion extension splinting (RMES) and controlled active motion (CAM) protocols. Similar outcomes are reported for most early active mobilization protocols, however reports on RMES protocols suggest a possible earlier return to work and functional use of the affected hand. To date no published prospective trials have compared the RMES to other early active mobilization protocols. This randomized clinical trial prospectively investigated whether patients with extensor tendon repairs in zone V and VI managed with an RMES protocol would return to functional use of the hand sooner than those managed with an extensor CAM protocol. Methods: Between January 2015 and February 2016, 42 participants who had undergone extensor tendon repair in zone V and/or VI were recruited to the study. They were randomized into 2 groups: one group was treated using a CAM protocol, the other an RMES yoke-only protocol. Participants were reviewed at 4 and 8 weeks post-operatively. The primary outcome was the Sollerman Hand Function Test (SHFT) score. Secondary outcomes were days to return to work, total active motion (TAM), grip strength and questionnaires including the QuickDASH (Disabilities of Arm, Shoulder and Hand) and satisfaction. Incidence of tendon rupture was recorded. Results: Results are as follows: SHFT mean score at 4 weeks: RMES 66 (SD: 7), CAM 59 (SD: 10), (p = 0.0073), SHFT at 8 weeks RMES 76 (SD: 2), CAM 75 (SD: 5), (p = 0.63). Median days to return to work: RMES: 20 (IQR: 12, 57), CAM: 18 (IQR: 6, 55), (p = 0.77). QuickDASH 4 weeks: RMES 28.4 (SD: 14.5), CAM 40.7 (SD: 18), (p = 0.05). QuickDASH 8 weeks: RMES 11 (SD: 11), CAM 14 (SD: 13.1), (p = 0.35). TAM 4 weeks: RMES 185.9° (SD: 48.3), CAM 147.9° (SD: 41.7), (p = 0.008). TAM 8 weeks: RMES 236.4° (SD: 28.3), CAM 209.1° (SD: 37.6), (p = 0.030). Mean grip strength percentage of contralateral hand at 8 weeks: RMES 82.8% (SD: 23.7), CAM 73.8% (SD: 22.1), (p = 0.47). Mean percentage satisfaction with splint: RMES 75.9% (SD: 17.3), CAM 43% (SD: 22.2), (p < 0.0001). No tendon ruptures occurred, one RMES participant underwent tenolysis surgery. Conclusions: This is the first randomized clinical trial to prospectively compare an RMES protocol to a CAM protocol. Participants treated with an RMES protocol demonstrated better early return to functional use of the hand than those treated with a CAM protocol, and RMES participants continued to show better range of motion to CAM participants at eight weeks. RMES participants were also more satisfied with splinting than CAM participants. There was no difference in return to work timeframes, possibly due to factors outside the control of the study. No ruptures occurred in either group, complication rates were low and not significantly different between groups. This study has demonstrated that an RMES protocol provides an earlier return to hand function than a CAM protocol for the patients who have undergone extensor tendon repair in zones V and VI.

Spontaneous Extensor Tendon Rupture in the Rheumatoid Wrist: Risk Factors and Preventive Role of Extended Tenosynovectomy.

Spontaneous extensor tendon rupture is often seen in rheumatoid arthritis (RA) patients, but the risk factors are not clearly defined. We therefore collected the data of RA patients with previous extensor tendon rupture and those with tenosynovitis and analyzed the relationship between extended tenosynovectomy and spontaneous extensor tendon rupture. We retrospectively reviewed 17 spontaneous extensor tendon rupture episodes in 15 RA patients and 14 tenosynovitis episodes that required tenosynovectomy in 12 RA patients from 1997 to 2013. Correlations between the incidence of tendon rupture, X-ray findings, and clinical findings in the affected wrists before tendon rupture were analyzed statistically using the test for proportion. The following parameters were significantly correlated with spontaneous extensor tendon rupture: disease duration longer than 8 years, persistent tenosynovitis longer than 1 year duration, and Larsen grade greater than 4 (P = 0.02, 0.03, and 0.01, respectively). Dislocation of the distal end of the ulna, carpal collapse, and the scallop sign on X-ray contributed to a higher spontaneous extensor tendon rupture rate among RA patients (P = 0.01, 0.05, and 0.03, respectively). Extended tenosynovectomy was performed on 14 wrists in 12 RA patients with persistent tenosynovitis longer than 6 months, and Larsen grade did not deteriorate in this group compared with those who did not undergo the surgery. No spontaneous extensor tendon rupture occurred following the surgery. Risk factors of spontaneous extensor tendon rupture included disease duration longer than 8 years, persistent tenosynovitis longer than 1 year, and wrist Larsen grade greater than 4. Dislocation of the distal end of the ulna, carpal collapse, and the scallop sign on X-ray indicated a higher probability of extensor tendon rupture. Rheumatologists should consult with hand surgeons promptly to preserve hand function before tendon rupture. Prophylactic extended tenosynovectomy surgery to prevent more severe damage of extensor tendon should be recommended in patients who had the above risk factors.

Is intramedullary nailing better than the use of volar locking plates for fractures of the distal radius? A meta-analysis of randomized controlled trials.

We conducted a meta-analysis of randomized controlled trials that compared the use of intramedullary nails and volar locking plates in distal radial fractures. PubMed, EMBASE and the Cochrane Collaboration Central database were used to find randomized controlled trials that met the eligibility criteria. Two reviewers screened the studies, extracted the data, evaluated the methodological quality and analysed the data with RevMan 5.1 software. No statistically significant differences were detected in the disability of the arm, shoulder and hand and the Gartland and Werley scores, radiographic parameters, wrist range of motion, grip strength, total complication rate and incidence of tendon rupture between the two groups. However, carpal tunnel syndrome occurred less often after intramedullary nailing. The two fixation methods achieved equal clinical, functional and radiological outcomes for primary fixation of the indicated types of distal radial fractures. Therapeutic/LevelI.

Flexor Tendon Repair Rehabilitation Protocols: A Systematic Review

To systematically review various flexor tendon rehabilitation protocols and to contrast those using early passive versus early active range of motion. We searched PubMed and Cochrane Library databases to identify articles involving flexor tendon injury, repair, and rehabilitation protocols. All zones of injury were included. Articles were classified based on the protocol used during early rehabilitation. We analyzed clinical outcomes, focusing on incidence of tendon rupture and postoperative functional range of motion. We also analyzed the chronological incidence of published tendon rupture with respect to the protocol used. We identified 170 articles, and 34 met our criteria, with evidence ranging from level I to level IV. Early passive motion, including both Duran and Kleinert type protocols, results included 57 ruptures (4%) and 149 fingers (9%) with decreased range of motion of 1598 tendon repairs. Early active motion results included 75 ruptures (5%) and 80 fingers (6%) with decreased range of motion of 1412 tendon repairs. Early passive range of motion protocols had a statistically significantly decreased risk for tendon rupture but an increased risk for postoperative decreased range of motion compared to early active motion protocols. When analyzing published articles chronologically, we found a statistically significant trend that overall (passive and active rehabilitation) rupture rates have decreased over time. Analyzing all flexor tendon zones and literature of all levels of evidence, our data show a higher risk of complication involving decreased postoperative digit range of motion in the passive protocols and a higher risk of rupture in early active motion protocols. However, modern improvements in surgical technique, materials, and rehabilitation may now allow for early active motion rehabilitation that can provide better postoperative motion while maintaining low rupture rates.

The effectiveness of early mobilization after tendon transfers in the hand: A systematic review

Study DesignSystematic review. IntroductionOver the past decade, early mobilization (initiated within a week) has become an increasing trend in postoperative rehabilitation after tendon transfer surgery in the hand. However, there are no published reviews summarizing the effectiveness of early mobilization protocols in comparison with conventional immobilization in tendon transfer rehabilitation. PurposeTo systematically review available evidence on the effectiveness of early mobilization protocols to conventional immobilization protocol after tendon transfers in the hand. MethodsA literature search of the Cochrane Library, PubMed, PEDro, EMBASE, and CINAHL databases was conducted (1980 to date). Randomized controlled trials (RCTs), case–control, and other study designs were included. Six articles were eligible for inclusion in the analysis (five RCTs and one retrospective study) and 260 articles that did not meet inclusion criteria were excluded. Level of evidence (Center for Evidence-based Medicine) and methodological quality (Structured Effectiveness Quality Evaluation Scale [SEQES] score) of each study were assessed by two independent reviewers. ResultsThis review found three high quality trials (SEQES score: 35–43 of 48), with level 1b and 2b evidence, supporting early mobilization of tendon transfers. The literature reports reduced total cost, total rehabilitation time, and demonstrates that early mobilization is a safe approach with no incidence of tendon ruptures or insertion pull out. In the initial phase of rehabilitation, outcomes like range of motion, grip strength, pinch strength, total active motion of digits, deformity correction, and tendon transfer integration were significantly superior with early mobilization compared with immobilization. However, in the long term, these outcomes were similar in both the groups, suggesting that early mobilization protocol improves hand function in the initial phase of rehabilitation (four weeks) and the long-term results (two months to one year) are equivalent to immobilization. ConclusionsBased on a limited number of small studies, there is evidence of short-term benefit for early mobilization, but inconclusive findings for longer-term outcomes. Until the body of evidence increases, clinicians should consider the clinical context, their experience in optimizing patient outcomes after surgery, and the patient's preferences when selecting between early and late mobilization after tendon transfer. Level of Evidence2a.

Early return to work and improved range of motion with modified relative motion splinting: a retrospective comparison with immobilization splinting for zones V and VI extensor tendon repairs

Introduction There is a lack of evidence on the best method for rehabilitating extensor tendon injuries in zones V and VI. The purpose of this study was to evaluate the outcomes of modified relative motion splinting compared with immobilization following repair of extensor tendons in zones V and VI. Methods A retrospective analysis compared the outcomes of relative motion splinting with immobilization. Sixteen patients (16 fingers) were treated by conventional immobilization splinting for four weeks (immobilization group) followed by mobilization with avoidance of ‘at-risk/heavy’ activities for a further 4–6 weeks. Twenty-three patients (23 fingers) were treated with the modified relative motion splint (mRMS group) during the day and a resting splint worn overnight for the first four weeks. The relative motion splint was continued for ‘at-risk/heavy’ activities for a further 4–6 weeks. Results The mRMS group demonstrated statistically significant improvement in range of motion compared with the immobilization group. This effect was most marked at six weeks ( P = 0.0194, two-way mixed ANOVA) with the mRMS group achieving a 12% higher mean percentage total active motion ( P = 0.0076, Mann-Whitney U test). Results were similar for both groups 12 weeks postoperatively. Differences in return to work times between groups were statistically significant ( P = 0.0062, Mann-Whitney U test). Average return to work was 9.4 weeks for the immobilization group and 3.3 weeks for the mRMS group, equating to a 42 days earlier return to work for the mRMS group. There was no incidence of tendon rupture in either group. Conclusion This study demonstrates that modified relative motion splintage (finger based without wrist component) can be applied in the postoperative management of single zone V or VI extensor tendon repairs. The main advantages of this protocol, compared with immobilization include the small simple splint design, and straightforward patient instructions that enable earlier mobilization, functional hand use and return to both daily living and work.

Peri-articular steroid injection improves the outcome after unicondylar knee replacement

We have performed a prospective double-blind, randomised controlled trial over two years to evaluate the efficacy and safety of an intra-operative peri-articular injection of triamcinolone acetonide in patients undergoing medial unicondylar knee replacement. We randomised 90 patients into two equal groups. The study group received an injection of triamcinolone acetonide, bupivacaine, and epinephrine into the peri-articular tissues at the end of the operation. The control group received the same injection mixture but without the addition of triamcinolone. The peri-operative analgesic regimen was standardised. The study group reported a significant reduction in pain (p = 0.014 at 12 hours, p = 0.031 at 18 hours and p = 0.031 at 24 hours) and had a better range of movement (p = 0.023 at three months). There was no significant difference in the rate of infection and no incidence of tendon rupture in either group. The addition of corticosteroid to the peri-articular injection after unicondylar knee replacement had both immediate and short-term benefits in terms of relief from pain, and rehabilitation with no increased risk of infection.

Fluoroquinolone use and the change in incidence of tendon ruptures in the Netherlands.

Shortly after their introduction, fluoroquinolones were associated with reports of tendinitis and tendon rupture. During the past years, the number of reports has risen, possibly because of an increased use of fluoroquinolones. In this study, we describe the use of fluoroquinolones in the Dutch community and the possible public health effects of an association between fluoroquinolone use and tendon ruptures. In the PHARMO drug database we identified all prescriptions for fluoroquinolones in the period 1991-1996. The incidence of fluoroquinolone use was expressed as the number of fluoroquinolone episodes per 1000 inhabitants in one year, and extrapolated to the Dutch population after standardisation on age and gender. The annual incidence of non-traumatic tendon ruptures in the period 1991-1996 was calculated with data from the nation-wide hospital registry. The expected number of fluoroquinolone attributable tendon ruptures was calculated on the basis of the use of fluoroquinolones, the number of non-traumatic tendon ruptures and an assumed relative risk of 1.5-10. In 1996, approximately 251,000 patients experienced 318,000 episodes of fluoroquinolone use in the Netherlands. Females used more often fluoroquinolones than males, and the number of episodes increased exponentially with age. In the period 1991 through 1996, the absolute number of fluoroquinolone episodes increased by 160%, from 122,000 to 318,000. The absolute number of hospitalised tendon ruptures increased with 28%, from 768 in 1991 to 984 in 1996. Assuming a relative risk of 1.5 to 10.0, 1 to 15 tendon ruptures could be attributed to fluoroquinolone use in 1996. Only 7% of the observed increase could be attributed to the increased use of fluoroquinolones. If the total increase of hospitalised non-traumatic tendon ruptures would be attributable to the increase in fluoroquinolone use, this would mean that the risk of non traumatic tendon ruptures to fluoroquinolones would be more than 250 times the risk during non-use. In the Netherlands, a large simultaneous increase in non-traumatic tendon ruptures and fluoroquinolone use was observed in the period between 1991 to 1996. Assuming a relative risk of 1.5 to 10.0 for tendon ruptures during fluoroquinolone use, only 0.5 to 7% of the increase in non-traumatic tendon ruptures could be attributed to the increased fluoroquinolone use. The increase in the incidence of non-traumatic hospitalised tendon ruptures in the Netherlands is not likely to be explained solely by the increased use of fluoroquinolones.

The role of recreational sport activity in Achilles tendon rupture. A clinical, pathoanatomical, and sociological study of 292 cases.

During the last few decades, the incidence of tendon ruptures has increased in civilized countries. Our material comprises 749 patients who had 832 tendon ruptures treated surgically between 1972 and 1985. There were no competitive athletes among the patients studied. There were 292 single ruptures of the Achilles tendon, 274 of the proximal biceps brachii, 113 of the extensor pollicis longus, and 70 of other tendons. Forty-eight patients had multiple ruptures and 35 patients had reruptures. Achilles tendon ruptures often occurred in recreational sports activities (59%), in contrast to other tendon ruptures (2%; P less than 0.001). The mean age for patients who had Achilles tendon rupture was 35.2 years and for patients with other ruptures, 50.7 years (P less than 0.001). There was a connection between the high incidence of blood group O and tendon ruptures (P less than 0.001). In cases of multiple ruptures and reruptures, the frequency of blood group O was 71%. Sixty-two point three percent of the patients with Achilles tendon rupture were professionals or white collar workers, which is markedly more than in the Hungarian population (12.7%; P less than 0.001). Two hundred and six Achilles tendon ruptures were studied histologically, and all cases displayed pathological alterations. The results indicate that complete rupture of the Achilles tendon is usually a sequel to a sedentary life-style and participation in sports activities.

The role of flexor tenolysis in the palm and digits

Seventy-seven digitis in 70 patients undergoing a technique of thorough flexor tenolysis, with instillation of local triamcinolone, and immediate motion were studied. Classification of the results utilized a method which determined the percentage of passive joint flexion potential actively achieved and by a second system which graded the results in the finger as a whole. A further categorization into three patient groups, depending on the etiology of the tendon adhesions, was carried out. Using these classifications 84% or the proximal interphalangeal joints, 86% of the distal interphalangeal joints, and 80% of the fingers as a whole were improved by this procedure. These results were comparable or superior to those of other published reports. Improvement in digital flexion was consistent, often with restoration of near-normal function. The incidence of tendon rupture, infection, and delayed wound healing have not been great.