Drill Penetration Injury to Extensor Tendons: A Biomechanical Analysis

Mahylis, Jared M.; Burwell, Anora K.; Bonneau, Laura A.; Marshall, Lynn M.; Mirarchi, Adam J.

doi:10.1177/1558944716668824

Cited by 9 publications

(9 citation statements)

References 21 publications

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“…However, the quantity of tendon damage may not be of clinical relevance or require further clinical reconstruction (Colzani et al, 2016). In-vitro studies have shown that extensor tendon rupture after drill injury is rare and even lacerations of up to 75% may not fail under physiological load (Mahylis et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Cartilage and extensor tendon defects after headless compression screw fixation of phalangeal and metacarpal fractures

Urbanschitz

Dreu

Wagner

et al. 2020

J Hand Surg Eur Vol

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Osteosynthesis of metacarpal and phalangeal fractures with headless compression screws leads to a defect in the articular surface and possibly damage to the extensor tendons. This study aimed to quantify the articular surface defect and extensor tendon injuries after implant placement in cadaveric hands. Defect size was assessed with computed tomography. Extensor tendon injuries were assessed by direct visualization and measurement after dissection. In the middle phalanx, the defect size in relation to the joint surface was significantly smaller after anterograde screw placement when compared with retrograde placement. Also, a mini-open approach was found to cause significantly less tendon injury than a percutaneous approach, but there was no difference in tendon damage between retrograde and antegrade screw insertion into the middle phalanx.

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Section: Discussionmentioning

confidence: 99%

Cartilage and extensor tendon defects after headless compression screw fixation of phalangeal and metacarpal fractures

Urbanschitz

Dreu

Wagner

et al. 2020

J Hand Surg Eur Vol

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“…8,9 Multiple studies demonstrate plates to have higher breaking strength than HCS. 25,31,35 Melamed et al found an average load of failure in 2.4 mm IM screw of 75 ± 20 N in human cadaveric bone models. 30 This is compared with an average load of failure of over 200 N in 1.5 mm, 2.0 mm, locking, and nonlocking plate constructs.…”

Section: Discussionmentioning

confidence: 99%

“…In vitro studies have shown that extensor tendon rupture after drill injury is rare, and even lacerations of up to 75% may not fail under physiological load. 31 …”

Section: Pearls and Pitfallsmentioning

confidence: 99%

Intramedullary Screw Fixation Comprehensive Technique Guide for Metacarpal and Phalanx Fractures: Pearls and Pitfalls

Chao

Patel

Shah

2021

Plastic and Reconstructive Surgery - Global Open

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Background: Phalangeal and metacarpal fractures are the second and third most common upper extremity fractures after distal radius fractures with varying methods of fixation techniques. Intramedullary screw fixation is an increasingly preferred method of fixation. Benefits include early range of motion, faster recovery, limited dissection, and reduced complications. Improper technique, which is readily avoidable, can lead to suboptimal results. Methods: A review of recent literature on current techniques aims to summarize the biomechanics of intramedullary screw fixation and outline appropriate technique of placing headless compression screws for metacarpal and phalangeal fractures. Results: We discuss through images and videos the indications, preoperative workup, and technical pearls and pitfalls to encourage surgeons to add this technique to their armamentarium and improve outcomes. Conclusions: intrameduallry screw fixation is a powerful option for metacarpal and phalanx fixation that allows rigid stability, enabling early return of function with excellent rates of union and total active motion. With knowledge of technical pearls presented in this article, common mistakes can be avoided to improve efficiency of screw placement and optimize patient outcomes.

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“…The 2 reasons for irritation of the EPL resulting in tendon rupture have been reported to be a prominent screw or perforation of the dorsal surface intraoperatively with a drill bit [16,20,21]. When the patients visited our outpatient clinic with EPL tendon rupture, we conducted plain radiography and ultrasonography to confirm tendon rupture and determine whether screw penetration was present.…”

Section: Discussionmentioning

confidence: 99%

Extensor pollicis longus tendon rupture caused by a displaced dorsal “beak” fragment of Lister’s tubercle in distal radius fractures

Lee

Bang

Choi

et al. 2019

Handchir Mikrochir plast Chir

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Introduction Ruptures of the extensor pollicis longus (EPL) tendon are a well-known complication of distal radius fractures (DRF). There are a lot of suspected mechanisms, including mechanical friction, vascular impairment, injury associated with reduction, and local adhesion. However, there have been limited reports about a closed rupture of the EPL tendon associated with a relatively large, displaced dorsal “beak” fracture fragment. We report about the management outcomes and clinical significance of closed ruptures of the EPL tendon caused by a displaced dorsal fracture fragment of beak-like appearance in DRF. Patients/Material and Methods Our study included 7 cases of a complete closed rupture of the EPL tendon after open reduction internal fixation. All cases showed a similar pattern involving a relatively large dorsal beak fragment originating from Lister’s tubercle, and we treated them with a palmar locking plate within 7 days from the initial fracture without separate dorsal fragment management. All patients were diagnosed with a delayed EPL tendon rupture. Results The study included 5 female and 2 male patients. Mean patient age was 59 years. In all cases we explored the extensor compartment III to verify the exact cause of the EPL rupture. Six patients underwent an extensor indicis transfer and one patient underwent tendon grafting.Mean fragment width and length were 7.0 mm and 13.3 mm, respectively. The fragments were dorsally elevated (mean, 2.4 mm) and distally displaced (mean, 3.5 mm). At the last follow-up, the mean DASH score was 4.4. Mean thumb MP joint flexion and extension were 4 degrees and 62 degrees, respectively. Conclusion We support the possibility of EPL tendon rupture caused by displaced sharp Lister’s tubercle fracture fragments.

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Drill Penetration Injury to Extensor Tendons: A Biomechanical Analysis

Cited by 9 publications

References 21 publications

Cartilage and extensor tendon defects after headless compression screw fixation of phalangeal and metacarpal fractures

Cartilage and extensor tendon defects after headless compression screw fixation of phalangeal and metacarpal fractures

Intramedullary Screw Fixation Comprehensive Technique Guide for Metacarpal and Phalanx Fractures: Pearls and Pitfalls

Extensor pollicis longus tendon rupture caused by a displaced dorsal “beak” fragment of Lister’s tubercle in distal radius fractures

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