Extensor Tendon Rupture After Distal Radioulnar Joint Surgery: A Case Series

Abstract

Symptomatic arthritis of the distal radioulnar joint (DRUJ) is often treated nonoperatively but with persistent symptoms may be treated surgically with partial or complete distal ulna resection. In many of these cases, ulna resection in combination with tendon reconstruction can successfully restore hand function. We identified three patients who underwent the Darrach procedure to treat DRUJ arthritis that developed attritional ruptures due to sharp prominent bone edges or dorsal capsule disruption. In addition to our recent three patients, an additional three isolated case reports, and two cases in a 29-patient series reported post-operative extensor tendon rupture as a complication after a Darrach procedure more than 30 years ago. While extensor tendon rupture is rarely reported in recent literature as a complication of distal ulna excision, surgeons may be able to minimize the risk of this complication intra-operatively by ensuring the resected distal ulnar stump is smooth, free of bony prominences, any capsular deficiencies are reconstructed, and that extensor tendons are able to glide freely.

Attritional Extensor Digiti Minimi Tendon Rupture Associated With a Distal Ulna Fracture

“…Yamazaki H et al reported tendon ruptures in 37 patients with osteoarthritis, noting an increased risk of tendon rupture with associated scallop sign (sclerotic border of the ulnar aspect of distal radius), dorsal inclination of the sigmoid notch, and radial shift of the ulnar head relative to the radius. Case reports have also reported attritional extensor tendon ruptures in distal ulnar resection for DRUJ arthritis [ 12 , 13 ], scaphoid nonunion advanced collapse (SNAC) wrist [ 14 ], and Kienbock's disease [ 15 ]. Traumatic, non-arthritic tendon injuries most often result from incidents involving sharp objects or saws, typically affecting the dominant hand [ 16 ].…”

“…A similar mechanism was described by Fletcher C et al, where they demonstrated an extensor tendon rupture following distal radius excision. This rupture was attributed to a prominent dorsal distal ulna causing direct irritation to the extensor tendon, leading to an attritional rupture [ 12 ]. Similarly, in this case, we propose that the attritional EDM rupture was likely caused by the EDM tendon abutting the distal ulna fracture, resulting in direct tendon irritation and subsequent rupture.…”

Extensor Tendon Rupture in Ulnar Impingement Syndrome: A Case Report

“…This typically involves partial or complete distal ulnar resection and may be performed in combination with tendon reconstruction if extensor tendon rupture had occurred, as in our patient presented. There have also been case reports of extensor tendon rupture occurring post-operatively [9]. Fletcher et al recommend various intra-operative steps that may be undertaken to minimize the risk of this complication.…”

“…Fletcher et al recommend various intra-operative steps that may be undertaken to minimize the risk of this complication. This includes ensuring that the resected distal ulnar stump is smooth, that the DRUJ is free of bony prominences, that any capsular deficiencies are reconstructed, that the distal ulna and DRUJ are stabilized intra-operatively, and that the extensor tendons are able to move freely [9].…”