Delayed ruptures of the extensor tendon secondary to the use of volar locking compression plates for distal radial fractures

Al-Rashid, Mamun; Theivendran, Kanthan; Craigen, M. A. C.

doi:10.1302/0301-620x.88b12.17696

Cited by 174 publications

(147 citation statements)

References 20 publications

(15 reference statements)

Supporting

Mentioning

116

Contrasting

Unclassified

Order By: Relevance

“…Although volar plates are usually well tolerated, they can lead to impingement on the extensor tendons when the fixation screws are too long and extend beyond the dorsal cortex of the radius. This form of impingement has been reported in several articles in the orthopedics literature [8][9][10][11][12], but we are unaware of similar studies in the radiology literature.…”

Section: Sonography Of Screw Impingement On Extensor Tendons After Vomentioning

confidence: 67%

See 1 more Smart Citation

Screw Impingement on the Extensor Tendons in Distal Radius Fractures Treated by Volar Plating: Sonographic Appearance

Bianchi

Aaken²,

Glauser³

et al. 2008

American Journal of Roentgenology

View full text Add to dashboard Cite

W199age, 54 years). Three right wrists and six left wrists were affected. Four patients were referred with a presumptive diagnosis of complete extensor pollicis longus (EPL) tear and three had a diagnosis of tenosynovitis; one, a dorsal mass; and one, a ganglion cyst. Patients presented with local pain (n = 8), swelling (n = 7), and inability to extend the distal phalanx of the thumb (n = 4). Informed consent was obtained to search patients' data retrospectively. Institutional review board approval was obtained.All sonography examinations were performed by a trained musculoskeletal radiologist with 22 years of experience in musculoskeletal sonography. The mean delay between surgery and sonography examination was 7 months (range, 1-27 months). The dorsal aspect of the wrist was examined on transverse and sagittal sonograms obtained while the patient was seated in front of the examiner with the pronated wrist resting on an examination table. All 12 extensor tendons, running inside the six compartments, were carefully analyzed (Fig. 1). A broadband 17-5-MHz linear transducer (model iU22, Philips Healthcare) was used. No standoff pad was used, and transmission gel was used liberally. Attention was directed to looking for changes in the internal structure of the extensor tendons, thickening of the tendons' sheaths, and evidence of synovial effusions. The presence or absence of tendon tears was noted. We also evaluated focal interruption of the dorsal cortex of the distal radius, the number and location of detectable screw tips, and the length that each screw tip protruded using electronic calipers. In M u s c u l o s ke l e t a l I m ag i ng • C l i n ic a l O b s e r v a t io n ractures of the distal radius are frequent and their incidence can be expected to increase because the older population continues to increase in number [1]. Surgical treatment allows optimal fragment reduction and is advocated when a significant dorsal tilt is present or fractures are unstable. The most commonly performed surgical procedure is open reduction and internal fixation of the volar plate [1,2]. Tendon inflammation and tears are possible complications of that procedure due to dorsally protruding screw impingement on the extensor tendons. Sonography is a readily available and atraumatic imaging technique that allows accurate and inexpensive assessment of the musculoskeletal system [3]. The extensor tendons of the wrist are well depicted by high-resolution broadband electronic transducers because of their superficial location [3,4]. We present a retrospective analysis of the sonography examinations of nine consecutive patients presenting with screw impingement on the extensor tendons examined in the past 3.5 years. ObjeCtIve. The objective of our study was to analyze the sonography examinations of nine consecutive patients with a history of distal radius fracture treated by open reduction and internal fixation of the volar plate who were referred by hand surgeons for sonography of the dorsal aspect of the wrist. Screw Impingement o...

show abstract

Section: Sonography Of Screw Impingement On Extensor Tendons After Vomentioning

confidence: 67%

“…All were treated with Kirschner-wire fixation and not with volar plating [8]. Although the authors of several articles in the orthopedics literature have described extensor tendon tears caused by protruding screws [9][10][11][12], in none was sonography used preoperatively.…”

Section: Sonography Of Screw Impingement On Extensor Tendons After Vomentioning

confidence: 99%

Screw Impingement on the Extensor Tendons in Distal Radius Fractures Treated by Volar Plating: Sonographic Appearance

Bianchi

Aaken²,

Glauser³

et al. 2008

American Journal of Roentgenology

View full text Add to dashboard Cite

show abstract

“…Al-Rashid et al [31] reported an incidence of extensor tendon rupture of 8.6 % of 35 cases (three cases) treated with an AO volar locking plate, citing screw penetration of the dorsal cortex and careless drilling technique as principle causes. Other authors reporting extensor tendon irritation and ruptures have cited similar reasons [32][33][34][35].…”

Section: Discussionmentioning

confidence: 99%

Functional Outcome and Complications at 2.5 Years Following Volar Locking Plate Fixation of Distal Radius Fractures

et al. 2016

View full text Add to dashboard Cite

Distal radius fractures are increasingly treated by internal fixation, but there have been relatively few studies relating to functional outcome at 12 months or more. The aim of this study was to ascertain the patient reported function of the wrist at a minimum of 12 months following fixation of a distal radius fracture, the time taken to return to work, and the complication rate. We conducted a retrospective review of 187 consecutive patients treated by a specialist hand and wrist trauma team at a tertiary referral unit over a 5 year period. Mean age was 57.3 years (range 16-93). Median time to surgery was 4 days (interquartile range 2-9). Median follow up was 31 months (interquartile range 23-41 months). The median PRWE score was 3; (range 0-83). There was no difference in outcome in patients who had surgery delayed by greater than 2 weeks (p>0.05). The median time to return to work was 5 weeks (interquartile range 1-8 weeks). There were 15 complications (8 %) including 3 tendon injuries. We have demonstrated an early return to work in patients who were employed, a low complication rate, and highly favourable functional outcomes at a mean of 30 months postoperatively. We recommend the use of the DVR plate and involvement of a dedicated hand and wrist trauma team for treatment of unstable fractures of the distal radius.

show abstract

“…1 This technique can, however, be responsible for complications such as tendon rupture that are caused by screws passing through the dorsal cortex of the distal radius. [2][3][4] A tangential X-ray view of the dorsal distal radius, or "skyline" view, has been described to detect the screws that are too long. 5 The accuracy of this view has been validated by experimental studies.…”

mentioning

confidence: 99%

The Utility of the Fluoroscopic Skyline View During Volar Locking Plate Fixation of Distal Radius Fractures

et al. 2014

View full text Add to dashboard Cite

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

show abstract

Delayed ruptures of the extensor tendon secondary to the use of volar locking compression plates for distal radial fractures

Cited by 174 publications

References 20 publications

Screw Impingement on the Extensor Tendons in Distal Radius Fractures Treated by Volar Plating: Sonographic Appearance

Screw Impingement on the Extensor Tendons in Distal Radius Fractures Treated by Volar Plating: Sonographic Appearance

Functional Outcome and Complications at 2.5 Years Following Volar Locking Plate Fixation of Distal Radius Fractures

The Utility of the Fluoroscopic Skyline View During Volar Locking Plate Fixation of Distal Radius Fractures

Contact Info

Product

Resources

About