Transverse ultrasound assessment of the flexor pollicis longus tendon movement on the distal radius during wrist and finger motion in distal radius fracture with volar plating

Nanno, Mitsuhiko; Kodera, Norie; Tomori, Yuji; Takai, Shinro

doi:10.1007/s10396-015-0670-0

Cited by 10 publications

(21 citation statements)

References 9 publications

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“…However, the ulnoradial FPL position can change up to 3 mm, depending on the wrist and finger position showing a maximal ulnodorsal shift from a radiovolar position in wrist extension with finger flexion. 13,14 Additionally, the plate notch seemed to limit the ulnar shift if the FPL tendon showed a tendon-plate contact. 14 In summary, the wrist position might change the amount of partial tendon-plate overlap.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the FPL tendon course could just be estimated. Anatomical variations, wrist and finger positions 13,14,17 as well as X-ray rotation can also alter results and contribute to cases with a partial position of the tendon within the described corridor. Surgical fracture reduction and fixation might also change the position of the FPL tendon, potentially leading to a more ulnar position postoperatively than in healthy wrists.…”

Section: Limitationsmentioning

confidence: 99%

“…Surgical fracture reduction and fixation might also change the position of the FPL tendon, potentially leading to a more ulnar position postoperatively than in healthy wrists. 13,15,17 Finally, the clinical relevance of the tendon deformation and gliding restraint remains unclear and further research is necessary. This study did not evaluate specific wrist complains in regard to different FPL tendon positions.…”

Section: Limitationsmentioning

confidence: 99%

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Positioning of a Volar Locking Plate with a Central Flexor Pollicis Longus Tendon Notch in Distal Radius Fractures

et al. 2019

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Background Volar locking plates with a central notch were designed to reduce the risk of flexor pollicis longus (FPL) tendon irritation after volar plating for distal radius fractures. Objective The purpose of this study was to evaluate the course of the FPL tendon after FPL-plate osteosynthesis to identify a plate position that avoids an impingement with the FPL tendon. Patients and Methods Nineteen patients treated with volar plating using an FPL plate for a distal radius fracture were evaluated. Transverse ultrasound images were used to assess whether the profile of the FPL tendon lied within the plate notch. The position of the FPL tendon on transverse ultrasound images was transferred onto postoperative dorsovolar X-ray images to define an FPL tendon corridor for a plate position not interfering with the FPL tendon. Results The FPL tendon was aligned inside the plate notch completely in three cases, partially in 11 cases, and missed the notch in five cases. An FPL corridor was defined at the level of the watershed line with all FPL tendons being completely (74%) or partially (26%) aligned inside that corridor. There was a moderate correlation between the plate notch being positioned inside this corridor and the FPL tendon being positioned inside the plate notch (r = 0.49; p = 0.033). Conclusion It seems advantageous to place the plate notch within a corridor parallel to the radial shaft between the ulnar edge of the scaphoid tubercle and the scapholunate interval for the FPL tendon protection. Level of Evidence This is Level IV study.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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Positioning of a Volar Locking Plate with a Central Flexor Pollicis Longus Tendon Notch in Distal Radius Fractures

et al. 2019

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“…Therefore, because of the plate thickness, anything that would move the tendons away from the plate is supposed to prevent tendon injuries. Nanno et al observed that the transverse gliding area of the FPL at the volar distal radius rim could be covered by the PQ suture to protect the FPL from attrition on the plate. Then, suturing the PQ may act as a protective sleeve to protect the flexor tendons on the distal part of the plate, even if the suture is partial or loose .…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Evaluation of the Protector Role of the Pronator Quadratus Suture in Volar Plating

Walch

Erhard

Vogels

et al. 2019

J of Ultrasound Medicine

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The main complication of volar locking plates for distal radius fractures is flexor tendon rupture. The flexor pollicis longus (FPL) is the most commonly ruptured. Repair of the pronator quadratus (PQ) is one of the ways to prevent tendon rupture. The main purpose of this series was to evaluate the role of PQ repair after volar plating to prevent flexor tendon rupture using ultrasound (US). This work was a mono-operator prospective series of 20 consecutive patients with volar locking plates for distal radius fracture between September 2014 and May 2015. The PQ was repaired in all patients. A clinical, ultrasound, and perioperative evaluation of the flexor tendon was performed by this same surgeon. There was no flexor tendon rupture or tenosynovitis. There were no type A cases, which are characterized by contact between the plate and the FPL, and mostly type C cases, which are characterized by no contact between the plate and the FPL on US imaging. The suture of the PQ was sustainable over time when we removed the plate. Pronator quadratus repair is one of the ways to prevent flexor tendon rupture after volar plating. The outward-running suture is an effective technique for repairing the PQ. Ultrasound may be helpful during follow-up to detect asymptomatic flexor tendon irritation.

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“…Most flexor tendon ruptures are caused by friction between the prominent volar distal edge of the plate and the flexor tendon. Recently, ultrasonography has become a useful method for early detection of FPL tendon attrition and prevention of FPL tendon rupture following volar locking plate fixation of distal radius fractures [8][9][10][11][12]. However, rarely, the volar locking plate itself entraps the FPL tendon entirely and causes its rupture, which has never been previously evaluated with ultrasonography.…”

Section: Introductionmentioning

confidence: 99%

Flexor pollicis longus tendon rupture by sandwiched underlying volar locking plate and distal radius

et al. 2018

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Flexor pollicis longus (FPL) tendon rupture is a major complication of volar locking plate fixation for distal radius fractures. The tendon rupture is usually caused by friction between the distal edge of the plate and the FPL tendon, and has been well detected recently with ultrasonography. Rarely, the volar locking plate itself entraps the FPL tendon, leading to its rupture. A 63-year-old man was consistently unable to flex his right thumb after previous surgery for a distal radius fracture at another hospital. Ultrasonography demonstrated loss of tendon gliding and unusual patterns of the FPL tendon. The tendon was sandwiched between the plate and the distal radius, and was penetrated by the distal locking screw, which was comparable to intraoperative findings of complete entrapment and rupture of the FPL tendon from the underlying plate. The tendon defects were repaired using a palmaris longus tendon graft after removing the screws and plate. Finally, he could flex his thumb actively with satisfaction. Unusual patterns of FPL tendon rupture buried under inadequate plate positioning must be recognized, as in this case. Ultrasonographic assessment is routinely recommended to visibly determine any FPL tendon damage after volar locking plate fixation for distal radius fractures.

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Transverse ultrasound assessment of the flexor pollicis longus tendon movement on the distal radius during wrist and finger motion in distal radius fracture with volar plating

Cited by 10 publications

References 9 publications

Positioning of a Volar Locking Plate with a Central Flexor Pollicis Longus Tendon Notch in Distal Radius Fractures

Positioning of a Volar Locking Plate with a Central Flexor Pollicis Longus Tendon Notch in Distal Radius Fractures

Ultrasound Evaluation of the Protector Role of the Pronator Quadratus Suture in Volar Plating

Flexor pollicis longus tendon rupture by sandwiched underlying volar locking plate and distal radius

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