Extensor Tendon Rupture Research Articles

Ciprofloxacin-Induced Extensor Tendon Rupture in the Hand: A Case Report.

An eighty-one-year-old man had begun taking ciprofloxacin one week prior to the sudden inability to extend the metacarpophalangeal joint of the ring finger of the dominant right hand. He presented to us three months after he initially noticed this finding. Ciprofloxacin-induced tendon rupture appears to be possible in the extensor digitorum communis tendons of the hand. Our patient was managed operatively and had a good functional outcome.

Predicting a Safe Screw Length for Volar Plate Fixation of Distal Radius Fractures: Lunate Depth as a Marker for Distal Radius Depth

We hypothesized that the lunate depth as measured on plain lateral radiographs can be used to predict distal radius depth radially and ulnarly and serve as a useful reference for intraoperative screw placement in volar plate fixation of distal radius fractures. Plain radiographs and magnetic resonance imaging (MRI) of the wrists of 30 patients were reviewed. The lunate depth and the maximal depth of the distal radius were determined from plain lateral radiographs. Depth of the distal radius, measured in quartiles, was determined from axial MRI images, and the lunate depth was obtained from sagittal MRI images. The depth of the distal radius in each quartile was then calculated related to the lunate depth. The mean depth of the lunate on plain radiographs and MRI was 17.5 mm and 17.4 mm, respectively. The depth of the distal radius from ulnar to radial was 18.4 mm, 20.2 mm, 19.4 mm, and 15.1 mm for the 1st through 4th quartiles, respectively. The depth of the distal radius is the least radially (4th quartile), with a mean 87% of the lunate depth, and greatest in the 2nd quartile, with a mean 116% of the lunate depth. The depth of the lunate as measured on plain radiographs can be used as a marker for drilling and placement of safe screw lengths during volar plate fixation of distal radius fractures. We recommend that surgeons use the lunate depth as an estimate for the length of their longest screw when fixing distal radius fractures with volar plate techniques to avoid extensor tendon irritation and rupture. Therapeutic III.

Extensor Pollicis Longus Ruptures Following Distal Radius Osteotomy

Introduction Extensor tendon ruptures may occur from closed as well as open treatment of distal radius fractures. Although rare, surgical corrections of malunited distal radii with volar osteotomy may carry a potential risk of rupture of the extensor tendons, most commonly the extensor pollicis longus (EPL). To investigate the etiology and pathological process involved in these complications, we had surgeons from multiple centers contribute cases for evaluation. Materials and Methods In this case series, we included patients with EPL ruptures who underwent distal radius osteotomies performed through a volar approach. Data was pooled from multiple surgical centers and compiled. Demographics, initial injury parameters, imaging studies, pre- and postoperative examination, intra-operative findings, surgical technique, and patient outcomes were compared and analyzed. Pre- and postoperative radiographs were evaluated and compared. Results Six cases from five surgeons in four institutions were evaluated. Length of follow-up ranged from one to over four years. Initial injuries included intra- and extra-articular fractures. All patients were initially treated with cast immobilization. Every patient in the study had limitation of range of motion preoperatively, most with primary loss of flexion. All malunions were healed in extension (20° to 60°) and with shortening. During the reconstructive operation deformity correction in the sagittal plane was 25° to 55°. All osteotomies were fixed with volar locking plates with autologous bone graft, except for one patient who received calcium phosphate-based bone-void filler. Postoperative X-rays suggested prominent osteotomy resection edges, osteophytes, or dorsal bony prominence due to healed callous. Every osteotomy united during the follow-up period. Average time from osteotomy to EPL rupture was 10 weeks [2 to 17 weeks]. Two patients initially refused to undergo tendon transfers. One was pleased with the outcome despite the ruptured EPL. The other patient ruptured two other extensor tendons and then underwent tendon transfers with good results. One patient ruptured the transferred tendon as well after two months and underwent successful tendon grafting. Conclusion Although extensor tendon ruptures following distal radius volar osteotomies are rare, they are a known complication of these corrective surgical procedures. In the absence of screw prominence, it is likely that dorsal callus, prominent osteotomy resection edges and osteophytes may attribute to attritional rupture of the EPL tendon.

Multi level Injury from High-energy Trauma in Sports: Case Report

Objective: Verify the efficacy of rehabilitative treatment according with splinting and early mobilization on a patient with joint and tendon injury after sport activity. Methods: The patient is a 39 years old caucasian man, he arrived at the emergency department for high-impact trauma during sport activity. The diagnosis was avulsion of the volar plate at the proximal phalanx and extensor tendon rupture at the distal phalanx. The surgical approach has been reinsertion of the volar plate at the base of the middle phalanx with 2 micromyteck anchors and extensor tendon tenorrafy after stabilization with transarticular Kirschner wire. He was subsequently subjected to early and protected mobilization program. The patient was assessed with the PRWHE, VAS and ROM every 7 days after surgery. Results: The results obtained following the setted clinical protocol are encouraging for the VAS, that improved from 8 to 2 points from the first to the last evaluation. Also the PRHWE index gave excellent results going from an initial value of 88/100 to a ending value of 3/100. Conclusions: The patient reached an excellent recovery of flexion-extension of the proximal interphalangeal joint and distal interphalangeal joint, he reintegrated gesture and functionality of the finger and hand in ADL and sport activities, thanks to an early mobilization protocol and to a continuous adaptation of the splinting.

Delineation of extensor tendon of the hand by MRI: usefulness of "soap-bubble" mip processing technique.

To evaluate the capability of the "Soap-Bubble" maximum intensity projection (MIP) processing technique in visualisation of extensor tendons of the hand, 36 intact subjects and seven patients with surgically confirmed extensor tendon rupture were examined. Three-dimensional T1-weighted turbo spin echo (3DT1TFE) MRI was performed using a sensitivity encoding flex coil, followed by Soap-Bubble MIP processing. For patients with extensor tendon ruptures, MRI findings and intraoperative findings were compared. As results, with only 3DT1TFE sequence, the entire extensor tendons that run along the arch of the hand were not shown on one image, but were visualised with addition of Soap-Bubble MIP. Although delineation of the extensor pollicis longus was poor in 27/43 subjects, it was much improved by the combination of water-suppression technique. MRI findings and intraoperative findings agreed in all patients. Soap-Bubble MIP processing with addition of water-suppression technique is considered useful for visualising the extensor tendons of the hand.

Extensor tendon rupture after hand cellulitis in a patient with dermatomyositis: a case report

Extensor tendon rupture after hand cellulitis in a patient with dermatomyositis: a case report

Dorsal Approach for Distal Radius Fractures

Since the advent of volar locking plate, volar approach for internal fixation has become a major trend in the treatment for unstable distal radius fracture. However, dorsal approach is preferred for certain fracture pattern include AO type C3, dorsal Barton’s fractures and concomitant intercarpal ligament injury, because it can afford excellent exposure of the articular surface. Although dorsal approach and plating technique has inherent disadvantages include extensor tendon irritation and rupture, improvements in implant design lead to decrease complication rate. Here, we provide overview of the pros and cons through historic perspective, indications, and surgical technique of the dorsal approach for the distal radius fracture.

Extensors tenosynovitis of wrist with rupture of extensor digitorum: rare presentation of tuberculosis

Majority of the non-pulmonary TB are seen in musculo skeletal system. It’s a chronic and progressive disease that mostly affects weight bearing joints. Upper extremity presentations are not common. Tendon sheaths constitute an uncommon target of extra articular tuberculosis. Tubercular tenosynovitis is now rare, which can delay diagnosis of this disease. Authors report a case of Tuberculosis Tenosynovitis affecting dorsum of hand with pathological rupture of extensor digitorum. A 60 year old male patient present with a progressive swelling over the dorsum of right wrist of 4 month duration. Later he was taken for open excision biopsy. Melon-seed bodies were found inside the exensor tendon sheath with complete rupture of extensor tendon. Case was managed by extensor sheath were excised and removed in total thorough irrigation of the wound was done, retinaculum is repaired, extensor tendons repaired. Histopathology confirmed Tuberculosis. Although the tendon sheath constitutes an uncommon target of extra articular TB, it is one of the leading causes of chronic tendon sheath infection. Hence should be considered in the differential diagnosis of hand masses.

Spontaneous extensor tendon ruptures in an old female with systemic lupus erythematosus; A case report

Spontaneous extensor tendon ruptures in an old female with systemic lupus erythematosus; A case report

Failed Extensor Indicis Proprius Tendon Transfer for Extensor Pollicis Longus Tendon Rupture after Distal Radial Fracture

The known complications of distal radial fractures (DRFs) include tendon rupture, tendon lag, trigger finger, and tenosynovitis. Open reduction and locking plate fixation via the volar approach for treatment of an unstable DRF is becoming an increasingly popular method and has been reported to cause tenosynovitis of the extensor tendons, which leads to delayed extensor tendon rupture. The extensor pollicis longus (EPL) tendon is most commonly ruptured. Screw penetration of the dorsal radius cortex to the third compartment after internal fixation of a volar plate for Failed Extensor Indicis Proprius Tendon Transfer for Extensor Pollicis Longus Tendon Rupture after Distal Radial Fracture

Spontaneous rupture of extensor tendons of the index finger. A report of two cases.

The closed rupture of the extensor tendons of the hand rarely occurs [6]. The isolated involvement of the extensor digitorum communis of the index finger (EDCI) and extensor indicisproprius (EIP) tendons after closed trauma barely appears in the literature [3, 6, 8, 9]. Spontaneous rupture of these tendons is described in patients with risk factors In the cases reported, such rupture takes place at the myotendinous junction level. In cases of spontaneous rupture, the direct reparation is unusual; conservative or surgical treatment through tenodesis or tendon transfer is preferable [6–9]. References about the spontaneous rupture of both extensor tendons of the index finger simultaneously have received scant attention in the literature.

Acute Compartment Syndrome in the Forearm with Extensor and Flexor Tendon Ruptures: A Case Report.

While working in a factory, a thirty-five-year-old man injured his right forearm and was then diagnosed with acute compartment syndrome. Ruptures of the flexor and extensor tendons were revealed via single volar and dorsal incisions. End-to-side transfer with use of the remaining extensor tendons was performed; the end of the extensor indicis proprius tendon was sutured to the side of the extensor digitorum communis tendon of the middle finger, and the extensor pollicis longus tendon was sutured to the extensor pollicis brevis tendon. In cases of high-energy injuries, associated tendon rupture should be considered.

Attritional Extensor Tendon Rupture in a Patient with Phialophora Verrucosa Tenosynovitis: Case Report

Deep tissue fungal infections of the hand are exceedingly uncommon. We present a case of fungal tenosynovitis caused by Phialophora verrucosa that led to extensor tendon rupture in a patient who was on chronic immunosuppressive therapy. Indolent fungal cysts can elude clinical diagnosis until excision is performed with definitive pathologic examination. In immunocompromised patients, antifungal therapy may be warranted after cyst excision even in the absence of acute infection to prevent subsequent progression to tenosynovitis.

Hardware-Related Complications After Dorsal Plating for Displaced Distal Radius Fractures

There has been a trend away from dorsal fixation of distal radius fractures secondary to a historically higher complication rate. However, the literature on low-profile dorsal plates and titanium implants for the treatment of these fractures is limited. The goal of the current study was to evaluate hardware-related complications and removal rates after open reduction and internal fixation of unstable, displaced distal radius fractures using a dorsal approach with a low-profile titanium plate. A single surgeon treated 125 patients with isolated, unstable, dorsally displaced distal radius fractures by open reduction and internal fixation using a low-profile titanium dorsal plating system. A total of 110 patients were followed for a minimum of 1 year, and mean follow-up was 27 months (range, 12-74). Outcomes were assessed radiographically and clinically. Satisfactory alignment was achieved in all cases, and no fracture went on to nonunion. Nine patients (8%) required removal of hardware at an average of 12 months (range, 6-34). Six patients (5%) had evidence of extensor tenosynovitis intraoperatively, but no extensor tendon ruptures were identified. Overall, using the Gartland and Werley score, results were excellent in 82 patients, good in 22 patients, fair in 5 patients, and poor in 1 patient. Six complications accounted for the fair and poor results. The average Disabilities of the Arm, Shoulder and Hand (DASH) score at latest follow-up was 6 (range, 0-25). This series showed that the technique of dorsal plating with a low-profile titanium plate is safe and effective.

The utility of the fluoroscopic skyline view during volar locking plate fixation of distal radius fractures.

Background Open reduction and internal fixation (ORIF) using a volar locking plate is a common method for treating displaced distal radius fractures. There is, however, the risk of extensor tendon rupture due to protrusion of the screw tips past the dorsal cortex, which cannot always be adequately seen on a lateral fluoroscopic view. We therefore wished to compare the sensitivity of an intraoperative fluoroscopic skyline view to a lateral fluorosocopic view in detecting past pointing of these screws. Material and Methods Our series included 75 patients with an average age of 59 years who underwent volar locked plate fixation of a displaced distal radius fracture. Intraoperative anteroposterior (AP), lateral, and skyline fluoroscopic views were performed in each case. The number of screws that were seen to protrude past the dorsal cortex of the distal fracture fragment were recorded for both the lateral and skyline views. The number of screws that required exchange was also documented. Results No screws were seen to protrude past the dorsal cortical bone on the lateral fluroscopic views. 15 of 300 screws (5%) were seen to protrude past the dorsal cortex by an average of 0.8 mm (range, 0.5 to 2 mm) and were exchanged for shorter screws in 11/75 patients. Conclusion Our results demonstrate that the skyline is more sensitive than a lateral fluoroscopic view at demonstrating protrusion of the screws in the distal fracture fragment following volar locked plate fixation. Level of Evidence IV.

Évaluation d’une modification de la technique d’arthrodèse totale du poignet rhumatoïde selon Mannerfelt. À propos de 19 cas

We studied a technical modification of Mannerfelt's total wrist fusion technique in a series of 19 wrists. A fully intramedullary technique without dorsal carpal fixation was used to protect the extensor tendons. Two intramedullary Rush pins without dorsal staples were used during the arthrodesis procedure. Nineteen rheumatoid arthritis wrists (2 bilateral cases) were reviewed with a mean follow-up of 4.9 years (range 2–10 years). Clinical outcomes were assessed using the VAS pain scale, DASH-score and wrist strength measurements. Wrist fusion was assessed on AP and lateral X-rays of the wrist. The position of the carpal Rush pin entry points and distal hook orientation were also assessed. Pain was 8.9 preoperatively and 1.1 at the last follow-up with 95% patients satisfied. Mean DASH-score was 46.9 points. The pinch strength was 79% and the grip strength was 68% of the contralateral wrist. Carpal height, carpal anterior subluxation and ulnar deviation were stable at the last follow-up. All of the wrists were in straight position and no extensor tendon ruptures were noted. Fusion was complete in all cases within 6 to 12 weeks, except in one case. The technical modification proposed in the current study —intraosseous fixation only— appears to be a good alternative to Mannerfelt's original technique. Every case treated with this modified technique had good functional results and none required pin removal.

Number of Ruptured Tendons and Surgical Delay as Prognostic Factors for the Surgical Repair of Extensor Tendon Ruptures in the Rheumatoid Wrist

Extensor tendon ruptures in the rheumatoid wrist are usually restored by extensor tendon reconstruction surgery. However, the factors significantly correlated with the outcomes of extensor tendon reconstruction have not been defined. We examined factors showing a statistically significant correlation with postoperative active motion after tendon reconstruction. Spontaneous extensor tendon ruptures of 66 wrists in patients (mean age, 52.6 yrs) with rheumatoid arthritis (RA) were evaluated. All patients underwent tendon reconstruction surgery with wrist arthroplasty or arthrodesis. Active ranges of motion of the affected fingers were evaluated at 12 weeks postsurgery. Statistical significance was determined using multiple and single regression analyses. Forty-six (69.6%) wrists had "good" results, while 13 (19.7%) and 7 (10.6%) wrists had "fair" and "poor" results, respectively. In multiple regression analysis, an increased number of ruptured tendons and the age at operation were independent variables significantly correlated with the postoperative active motion of reconstructed tendons (p = 0.009). Single regression analysis also showed a significant association between the number of ruptured tendons and surgical delay (p = 0.02). The number of ruptured extensor tendons was significantly correlated with the results of tendon reconstruction, and the number of ruptured tendons was significantly correlated with preoperative surgical delay. Our results indicate that, in patients presenting with possible finger extensor tendon rupture, rheumatologists should consult with hand surgeons promptly to preserve hand function.

Dorsal Plate Fixation for Dorsally Displaced Distal Radius Fractures

Received: February 4, 2014 Revised: March 10, 2014 Accepted: March 11, 2014 Correspondence to: Seok-Whan Song Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, The Catholic University of Korea College of Medicine, 10 63(yuksam)ro, Yeongdeungpo-gu, Seoul 150-713, Korea TEL: +82-2-3779-1192 FAX: +82-2-783-0252 E-mail: sw.song@catholic.ac.kr Purpose: The object of this study is to evaluate the clinical and radiographic outcomes of two different kinds of dorsal plating for dorsally displaced distal radius fractures. Methods: Forty-three patients with dorsal plate fixation for distal radius fracture were retrospectively reviewed. Twenty-four patients were treated with nonlocking dorsal plate (group I) and nineteen patients with locking dorsal plate (group II). Range of motion and Green and O’Brien score were evaluated as clinical results, and radial inclination, radial length, volar tilt at postoperative and last follow up were evaluated as radiographic results. Results: According to AO classification system, there were 18 type A fractures, 4 type B fractures, 21 type C fractures. In group I, the mean flexion and extension were 65.0° and 65.3°, respectively; ulnar and radial deviation were 25.5° and 20.8°; pronation and supination were 80.0° and 80.4°. In group II, the mean flexion and extension were 64.5° and 67.3°, respectively; ulnar and radial deviation were 30.6° and 20.6°; pronation and supination were 81.4° and 78.6°. The mean Green and O’Brien score was 94.4 in group I and 92.2 in group II, and 41 patients had satisfactory result. There was no statistical significant difference in clinical results between the groups. Results of postoperative and last follow-up radiographic analyses for mean radial inclination were 23.9° and 24.1° in group I, respectively, and 24.2° and 24.9° in group II; radial length were 9.9 mm and 9.7 mm in group I, and 10.1 mm and 9.2 mm in group II; mean volar tilt were 12.2° and 13.1° in group I, and 14.8° and 13.7° in group II . There were no statistical significant changes within radiographic parameters. No extensor tendon rupture was reported. Conclusion: Dorsal plate fixation for dorsally displaced distal radius fracture showed satisfactory clinical and radiographic outcomes with low complication rate, regardless of the type of plate.

Extensor tendon rupture caused by instability of the ulnar head with an osteoarthritic distal radioulnar joint: a case report

IntroductionAlthough spontaneous extensor tendon rupture often occurs in association with rheumatoid arthritis, extensor tendon rupture associated with osteoarthritis of the distal radioulnar joint has been rarely reported.Case presentationWe present the case of a 74-year-old Asian woman with a fourth and fifth extensor tendon rupture caused by instability of the ulnar head associated with an osteoarthritic distal radioulnar joint. Intraoperative findings showed that the cause of the dorsal capsular perforation and extensor tendon rupture was mechanical friction with the unstable ulnar head, which had no osteophytes or roughness. After tendon transfer and resection of the ulnar head, our patient can extend her ring and little fingers without difficulty for her daily activities.ConclusionsWhen a patient with osteoarthritic distal radioulnar joint has instability of the ulnar head and the ‘scallop sign’ on radiography, physicians should consider the possibility of extensor tendon rupture as a complication.

Avoiding extensor tendon rupture after the use of palmar locking plates for distal radial fractures

Avoiding extensor tendon rupture after the use of palmar locking plates for distal radial fractures