Extensor pollicis longus tendon rupture secondary to elastic intramedullary nailing of paediatric forearm fractures: how to avoid them?

Ellapparadja, Pregash; Hashmat, Iqbal; Takwale, V. J.

doi:10.1007/s00590-010-0716-3

Cited by 4 publications

(3 citation statements)

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“…A review of the literature identified nine previously reported cases of EPL rupture in association with dorsal entry site ESIN in children [ 2 , 4 , 11 , 12 , 23 – 25 ], although the majority of these were not reported in detail [ 2 , 11 , 12 ]. In our series, neither surgeon experience nor fatigue were contributory factors but, rather, it is the “blind” dorsal entry site that is inherently risky.…”

Section: Discussionmentioning

confidence: 99%

“…Delayed rupture has also been reported after closed treatment and after internal fixation with various devices, including volar locking plates [ 9 , 10 ]. However, rupture of the EPL tendon in children is rare and, as a complication of flexible nail insertion, has been only occasionally reported [ 11 ]. To our knowledge, there are only nine cases in the English literature, five of which were not reported in detail [ 2 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, rupture of the EPL tendon in children is rare and, as a complication of flexible nail insertion, has been only occasionally reported [ 11 ]. To our knowledge, there are only nine cases in the English literature, five of which were not reported in detail [ 2 , 11 , 12 ]. We report our experience of this complication, make recommendations regarding the choice of nail entry point and highlight the importance of early recognition of EPL dysfunction after radial ESIN.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Rupture of the extensor pollicis longus tendon following dorsal entry flexible nailing of radial shaft fractures in children

Brooker

Harris

Donnan

et al. 2014

Journal of Children's Orthopaedics

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IntroductionDiaphyseal forearm fractures are common in children and adolescents. Intramedullary fixation with flexible nails has a high success rate. Complications related to the insertion of the radial nail include injury to the superficial branch of the radial nerve and rupture of the extensor pollicis longus (EPL) tendon.Materials and MethodsWe report a series of nine patients who sustained an EPL injury related to the insertion of an elastic intramedullary nail into the radius.ResultsAll nine patients underwent operative management, consisting of either EPL release, EPL direct repair, or tendon transfer (using extensor indicis proprius). In all cases, the nail entry site was directly related to the location of EPL. In many of the cases the EPL dysfunction occurred early on but it’s recognition was often delayed.ConclusionBased on our findings, we recommend the use of a radial entry point. For surgeons who prefer the dorsal entry point, we recommend that they use an incision which allows visualisation of the extensor tendons and that any post-operative EPL dysfunction is addressed promptly.

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