Extensor Tendon Entrapment on Computed Tomography Imaging of Distal Radius Fractures

Abstract

Objective To examine the association between distal radius fractures and tendon entrapment identified on computed tomography (CT) imaging. Patients and Methods After Institutional Review Board approval, we retrospectively reviewed distal radius fractures that underwent CT imaging from an electronic database between January 2006 to February 2018 at a single level 1 hospital trauma center. We categorized all distal radial fractures according to the AO-OTA (AO Foundation/Orthopaedic Trauma Association) classification. Distal upper extremity tendons were assessed for entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. Results A total of 183 distal radius fractures were identified in 179 patients. A total of 16 fractures (13 males and 3 females) were associated with tendon entrapment. Mechanism of injury included falls (n = 7), motor vehicle accidents (n = 6), dog bites (n = 2), and gunshot wound (n = 1). Entrapped tendons were limited to the extensor compartment and included the extensor pollicis longus (EPL; n = 11), extensor pollicis brevis (n = 1), extensor carpi ulnaris (n = 1), extensor carpi radialis longus (n = 1), and extensor digitorum communis (n = 2). The most commonly associated AO-OTA fracture pattern with tendon entrapment was complete articular radial fractures (2R3C; 69%), eight of which were simple articular with metaphyseal multifragmentary fractures (2R3C2). Of the distal radius fractures, 81% were associated with additional ulnar fractures of varying severity and displacement. Conclusion Approximately 8.7% of distal radius fractures were retrospectively identified to have tendon entrapment compared with a previously reported incidence of 1.3%. Wrist surgeons and radiologists should have higher suspicion for tendon entrapment and carefully review preoperative CT imaging for tendon entrapment in distal radius fractures especially if there is an intra-articular, multifragmentary injury pattern. Wrist surgeons and radiologists should also have increased suspicion for EPL tendon entrapments given its high incidence in association with distal radius fractures. Level of Evidence This is a Level III, retrospective cross-sectional study.

Radial Wrist Extensor Tendon Entrapment in Volarly Displaced Distal Radius Fracture

“…In Galeazzi's fractures, the extensor carpi ulnaris tendon may also be involved 6 . Nigh retrospectively reviewed their cases and found a case with ECRL tendon entrapment in computed tomography; however, it was not noted in the operative report 1 . To the best of our knowledge, intraoperatively confirmed entrapment of radial wrist extensor tendons at the fracture site has not been previously reported.…”

“…E xtensor tendon entrapment at the fracture site is one of the complications in volarly displaced distal radius fracture known as Smith-type fracture or Goyrand-type fracture 7,8 The most commonly associated AO Foundation and Orthopaedic Trauma Association fracture pattern with tendon entrapment is reported to be complete articular radial fractures (2R3C; 69%) 1 . There are reports on entrapments of EPL, EIP, and EDC tendons, of which the EPL tendon is the most frequently involved.…”

“…Extensor tendon entrapment is one of the complications well-known to be related to Smith-type, or Goyrand-type in French literature, distal radius fractures 1 . In most of the reported cases, the extensor pollicis longus (EPL) tendon was entrapped 2,3 .…”

Diagnosis of a Rare Flexor Tendon Entrapment Using 3D CT Imaging Techniques

“…However, there is emerging evidence suggesting that CT imaging is a reasonable alternative to ultrasound and MRI for soft-tissue injuries. 1,[5][6][7][8] Several studies have demonstrated the utility of CT in visualizing lower extremity tendons as well as diagnosing tendon entrapment and rupture in complex fractures of the ankle and hindfoot. 7,8 In the forearm and hand, Sunagawa et al 5,6 demonstrated that 3D CT imaging can accurately identify flexor tendon rupture of the hand and wrist, locate tendon stumps, and evaluate extensor tendons proximal to the metacarpophalangeal joint.…”

“…However, such reports are few in number. [1][2][3][4] To our knowledge, there are no case reports of flexor tendon entrapment as a result of carpal fracture-dislocation.…”