Avulsion of the Extensor Carpi Radialis Brevis Insertion: A Case Report and Review of the Literature

Abstract

Injuries to the bases of the index finger and long finger metacarpals are unusual because of the stability of the carpometacarpal joints. Such stability is provided by the strong capsuloligamentous attachments and the unique bony architecture. Given the rare nature of these injuries, there is no consensus regarding the optimal management of avulsion fractures of the bases of the index finger and long finger metacarpals. Open reduction and internal fixation of the fracture, with anatomic repair of the extensor carpi radialis brevis or extensor carpi radialis longus, offers several advantages over closed treatment. A case report and a review of the literature are presented.

Management of Intra-Articular Metacarpal Base Fractures of the Second Through Fifth Metacarpals

“…3,[5][6][7][8] For second and third metacarpal base fractures, a history positive for an appropriate mechanism coupled with physical examination findings such as swelling, tenderness, bruising, abrasions, and abnormal bony prominence or palpable fragments should raise clinical suspicion. [1][2][3][4][5][7][8][9][10][11][12][13][14]17,29 The patient may also complain of limited and painful active wrist extension, pain with forced flexion of the wrist, or a decrease in grip strength. 1,3,6,8,9,11,12,14,29 Frank inability to extend the wrist may be found if simultaneous rupture of the extensor carpi radialis longus and the extensor carpi radialis brevis has occurred, in which case, attempts to actively extend the wrist may only result in painful ulnar deviation.…”

“…[1][2][3][4][5][7][8][9][10][11][12][13][14]17,29 The patient may also complain of limited and painful active wrist extension, pain with forced flexion of the wrist, or a decrease in grip strength. 1,3,6,8,9,11,12,14,29 Frank inability to extend the wrist may be found if simultaneous rupture of the extensor carpi radialis longus and the extensor carpi radialis brevis has occurred, in which case, attempts to actively extend the wrist may only result in painful ulnar deviation. 17 In addition to the range of motion of the fractured digit, the range of motion of the other digits (including the thumb) should be assessed as well, as displaced fracture fragments have been reported to disrupt or interfere with other extensor tendons.…”

“…6 Our literature review revealed 7 cases involving isolated fractures of the base of the third metacarpal. 8,11,14,17,29,33,34 Some cases involved a fracture fragment still attached to the tendon of the extensor carpi radialis brevis, 8,11,29 whereas in other cases the bony fragment separated free. 17 In every case, however, the authors recommended surgical treatment.…”

Small flake, big problem: an unreported cause of extensor pollicis longus tendon rupture

“…3,4 Rupture of the extensor pollicis longus (EPL) tendon is a well-known injury, with a multifactorial aetiology.…”

“…1,2 Isolated avulsion of the insertion of the extensor carpi radialis brevis (ECRB) tendon from the base of the third metacarpal has been described only 6 times. 3,4 Rupture of the extensor pollicis longus (EPL) tendon is a well-known injury, with a multifactorial aetiology. 5 Attrition rupture of the EPL caused by an avulsed fragment of bone from the long radial wrist extensor (ECRL) has been reported in the literature only twice.…”