E arly rupture of the ex t en s or pollici s long u s t endon af ter f racture of the di s tal end of the radiu s - A c as e report -

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1 3 1 Vol. 3, No 1, J une * =A bs tract = E arly rupture of the ex t en s or pollici s long u s t endon af ter f racture of the di s tal end of the radiu s - A c as e report - Suk Woong Yoon, M.D., T ae Sung Hwang, M.D., and Jeong Il An, M.D. Departm ent of Orthop edic S urgery, Seoul R ed Cross H osp ital Extensor pollicis longus tendon rupture is well known as a complication of fracture of the distal radius. There is a higher risk that the tendon of extensor pollicis longus will rupture in undisplaced distal radius fracture than in those which are displaced. This difference in incidence is due to the integrity of the extensor retinaculum in undisplaced distal radius fracture causing the tendon to be held tight against the fracture callus in the floor of the tunnel which may result in an attrition rupture. In the displaced distal radius fracture the extensor retinaculum is torn from the bone and thus permits the tendon to escape from contact with the fracture site. Early disruption of the extensor pollicis longus tendon as a complication of undisplaced distal radius fracture is not common. We have experienced one case of early disruption of the extensor pollicis longus tendon after undisplaced distal radius fracture. It was treated by end- to- end anastomosis. After initial trauma of the distal radius fracture, careful evaluation of extensor pollicis longus tendon was needed. Key Words : extensor pollicis longus, rupture, distal radius fracture, undisplaced :

2 , 1876 Duplay 4),,, 1,, (splint), 3 5cm, 4 6 (Fig. 4), 8 (Fig. 5-A, B) 60 2 (Fig.1), (Fig. 2),, CBC, CRP, RA, (Fig. 3)., 4 40 Fig. 1. Initial AP and Lat. roentgenogram. Fig. 2. Spontaneous rupture of the extensor tendon. There is loss of extension at the interphalangeal joint and metacapophalangeal joint

3 Fig. 3. Intra- operative photograph shows rupture of EPL just below intact extensor retinculum. Fig. 5- B. Post- operative 8 weeks photograph shows extension state of thumb. Fig. 4. Post- operative 6 weeks AP and Lat. roentgenogram shows union state. Fig. 5- A. Post- operative 8 weeks photograph shows flextion state of thumb., 7),12). Cassebaum 1), Cooney 2) Witter 16) 0.2%, Frykman 6) 0.7%, Hove 9) 0.3% 12), Mendelaar 11) 2-8, Frykman 6) 4-12, Engkvist Lundborg 5) 70% 8, 16) 5, 7, 12) Engkvist, Lundborg 5) Hirasawa 8) Lister 3, (mesotenon),

4 (visceral layer) 5 mm,, Lister 3, McMaster 10), Denman 3), Stahl Wolff 14) Lister,, 9),, 3 13).,, 12), Trevor 15),,,, 1) Cassebaum WH : Colles' fracture: A study of end results. J Am M ed Assoc, 143 : , ) Cooney WP, Dobyns JH, Linsheid RL : Complications of Colles' fractures. J B one Joint Surg, 62(A) : , ) Denman EE : Rupture of the extensor pollicis longus-a crush injury. The Hand, 11 : , ) Duplay S : Rupture sous- cutanée du tendon du long extenseur du pouce de la main droite, au niveau de la tabatiére anatomique. Flexion permanente du pouce. Rétablissement de la faculté d' extension par une opération (suture de l'extrémité du tendon rompu avec le

5 premier radial externe). Bulletins et Mémoires de la Société de Chirurgie de Paris, 2: , 1876(cited from Kenneth Christophe: Rupture of the extensor pollicis longus tendon following Colles' fracture. J B one Joint Surg, 35-A : , ) Engkvist O, Lundborg G : Rupture of the extensor pollicis longus tendon after fracture of the lower end of the radius-a clinical and microangiographic study. The Hand, 11 : 76-86, ) Frykman G : Fracture of the distal radius including Sequelae Shoulder- Hand-Finger Syndrome, Disturbance In The Distal Radio- Ulnar Joint And Impairment Of Nerve Function. A cta Orthop Scand Supplementum, 108 : 127, ) Helal B, Chen SC and Iw egbu G : Rupture of the extensor pollicis longus tendon in undisplaced Colles' type of fracture. The Hand, 14 : 41-47, ) Hirasaw a Y, Katsumi Y, Akiyoshi T, T amai K, T okioka T : Clinical and microangiographic studies on rupture of the E.P.L tendon after distal radial fractures. J Hand Surg(B r), 15B : 51-57, ) Hov e LM : Delayed rupture of the thumb extensor tendon. A cta Orthop Scand, 65(2) : , ) McMaster PE : Late ruptures of extensor and flexor pollicis longus tendons following Colles' fracture. J B one Joint Surg(Am), 14:93-101, ) Mendelaar HM : Posttraumatic ruptures of the tendon of the musculus extensor pollicis longus. A rchivum Chirurgicum N eerlandicum, 12 : , ) Raoul Tubiana : The Hand. 1st ed, Philadelphia, WB Saunders Co : , ) Robert J, Alfred V : Concomitant skeletal and soft tissue injuries. Orthop edic Clinics of N orth A merica, 24 : , ) Stahl S, Wolff T W : Delayed rupture of the extensor pollicis longus tendon after nonunion of a fracture of the dorsal radial tubercle. J Hand Surg, 13A(3) : , ) Trevor D : Rupture of extensor pollicis longus tendon after Colles' fracture. J B one Joint Surg, 32B : , ) Witter H : Rupture der Sehne des Musculus extensor pollicis longus als Komplikation der Radiusfraktur. Beiträge zur klinischen Chirurgie, 201 : , 1960(cited from Ove Engkvist and Göran Lundborg: Rupture of the extensor pollicis longus tendon after fracture of the lower end of the radius-a clinical and microangiographic study. The Hand, 11 : 76-86,