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

Abstract

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.

Attritional rupture of the extensor pollicis longus tendon due to calcified extensor carpi radialis tendon group: a case report

“…Other factors that cause SREPL were reported as systemic or local steroid injections, wrist fracture, tenosynovitis, synovitis, RA, gouty tenosynovitis, and repetitive hand and wrist motions (such as milking cow, goalkeeping, or downhill skiing). [1][2][3][4][5][6][7][8] In our case, we could not find any correlation with the causes of calcific tendinitis that were mentioned above.…”

“…[1][2][3][4][5][6][7][8] This report presents an attritional SREPL related calcific extensor carpi radialis tendon group (ECRTG) in a farmer patient with no apparent predisposing factor, which has not been published in the literature previously. [9] …”

The effects of radial bowing and complications in intramedullary nail fixation of adult forearm fractures

“…In a recent study, nine cases of rupture of EPL tendon following dorsal entry flexible nailing of radial shaft fractures in children have been reported. [17] Extensor pollicis longus rupture may be more common than reported in the literature and to prevent this significant complication, a radial entry point is recommended. [17] The high incidence of EPL rupture may be due to our technical errors leading to tendon irritation related to prominent implant or related to ulnar entry point as described in the surgical technique of the nail used.…”

“…[17] Extensor pollicis longus rupture may be more common than reported in the literature and to prevent this significant complication, a radial entry point is recommended. [17] The high incidence of EPL rupture may be due to our technical errors leading to tendon irritation related to prominent implant or related to ulnar entry point as described in the surgical technique of the nail used. Extensor pollicis longus ruptures have been reported previously with different designs of nails all inserted from the fourth compartment ulnar to Lister tubercle.…”

“…Twenty three patients with acute adult forearm diaphyseal fractures -11 with isolated radius and 12 with both-bone forearm fractures- (17 (Table I).…”