Cause of Extensor Pollicis Longus Ruptures After Distal Radius Fracture Fixation Using a Volar Plate

Overview

Journal Hand (N Y)

Publisher Sage Publications

Specialties General Surgery
Orthopedics

Date 2024 Feb 29

PMID 38420781

Authors

Charlotte L E Laane

Anjuli L Dijkmans

Chelsea J Messinger

Mathieu M E Wijffels

Abhiram R Bhashyam

Neal C Chen

Affiliations

Soon will be listed here.

Abstract

Background: This research sought to analyze a cohort of patients with extensor pollicis longus (EPL) ruptures after volar locked plating of a distal radius fracture (DRF) to characterize the incidence of ruptures that are unlikely to be related to dorsal screw prominence.

Methods: This is a retrospective, observational, descriptive cohort study of adults with operative fixation of a closed DRF and an EPL rupture between 2002 and 2022. Eighteen patients with operative fixation using a volar plate of a closed DRF had an EPL rupture. The cohort consisted of 66% women with an average age of 57.5 years. Median follow-up was 14.5 months.

Results: The incidence of EPL rupture was 0.4% (18/4768). The average time from DRF and DRF fixation to EPL rupture was 3.7 and 3.4 months, respectively. Based on the operative record, in 2 of the 18 patients (11%), the rupture was directly attributable to prominent hardware; however, in 4 of the 18 patients (22%), the rupture was not related to prominent hardware, and the cause was indeterminate in 12 patients (67%). Radiologic analysis of those in the indeterminate group demonstrated that 5 of the 12 patients had screws that had a high probability of being prominent.

Conclusions: The incidence of EPL rupture after volar plating of DRF is between 0% and 1% and usually occurs about 3 months after fixation. Approximately 50% of EPL ruptures are attributable to prominent dorsal screws. Although screw prominence is an important cause of EPL rupture, it is not the sole cause of rupture.

Citing Articles

Extensor Pollicis Longus Entrapment on CT in Acute Distal Radius Fracture May Be a Predictor of Tendon Rupture.

Laane C, Husseini J, Huang A, Balza Romero R, Stam M, Chen N Hand (N Y). 2025; :15589447251315748.

PMID: 39921558 PMC: 11807270. DOI: 10.1177/15589447251315748.

References

Mattila V, Huttunen T, Sillanpaa P, Niemi S, Pihlajamaki H, Kannus P . Significant change in the surgical treatment of distal radius fractures: a nationwide study between 1998 and 2008 in Finland. J Trauma. 2011; 71(4):939-42. DOI: 10.1097/TA.0b013e3182231af9. View

Cha S, Shin H, Lee S . "Island-shape" Fractures of Lister's tubercle have an increased risk of delayed extensor pollicis longus rupture in distal radial fractures: After surgical treatment by volar locking plate. Injury. 2018; 49(10):1816-1821. DOI: 10.1016/j.injury.2018.08.019. View

Griffin J, Chhabra A . Complications after volar plating of distal radius fractures. J Hand Surg Am. 2014; 39(6):1183-5. DOI: 10.1016/j.jhsa.2014.03.038. View

Yang J, Wang C, Lin W, Li C, Su F, Jou I . Comparison of ultrasound and dorsal tangential view for dorsal cortex screw penetration in volar plating of the distal radius. J Orthop Res. 2022; 41(1):235-240. DOI: 10.1002/jor.25341. View

Kunes J, Hong D, Hellwinkel J, Tedesco L, Strauch R . Extensor Tendon Injury After Volar Locking Plating for Distal Radius Fractures: A Systematic Review. Hand (N Y). 2022; 17(1_suppl):87S-94S. PMC: 9793626. DOI: 10.1177/15589447211068186. View

Al-Rashid M, Theivendran K, Craigen M . Delayed ruptures of the extensor tendon secondary to the use of volar locking compression plates for distal radial fractures. J Bone Joint Surg Br. 2006; 88(12):1610-2. DOI: 10.1302/0301-620X.88B12.17696. View

Sun S, Geannette C, Braun N, Wolfe S, Endo Y . Diagnostic ultrasound of tendon injuries in the setting of distal radius fractures. Skeletal Radiol. 2022; 51(7):1463-1472. DOI: 10.1007/s00256-021-03985-4. View

Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M . Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma. 2007; 21(5):316-22. DOI: 10.1097/BOT.0b013e318059b993. View

Letissier H, Dardenne G, Stindel E, Borotikar B, Le Nen D, Kerfant N . Predicting epiphyseal screw length in anterior plating of distal radial fractures. J Hand Surg Eur Vol. 2019; 45(4):354-359. DOI: 10.1177/1753193419841269. View

10.

Bergsma M, Denk K, Doornberg J, van den Bekerom M, Kerkhoffs G, Jaarsma R . Volar Plating: Imaging Modalities for the Detection of Screw Penetration. J Wrist Surg. 2019; 8(6):520-530. PMC: 6892657. DOI: 10.1055/s-0039-1681026. View

11.

Azzi A, AlDekhayel S, Boehm K, Zadeh T . Tendon Rupture and Tenosynovitis following Internal Fixation of Distal Radius Fractures: A Systematic Review. Plast Reconstr Surg. 2017; 139(3):717e-724e. DOI: 10.1097/PRS.0000000000003076. View

12.

Ljungquist K, Agnew S, Huang J . Predicting a safe screw length for volar plate fixation of distal radius fractures: lunate depth as a marker for distal radius depth. J Hand Surg Am. 2015; 40(5):940-4. DOI: 10.1016/j.jhsa.2015.01.008. View

13.

Rosenauer R, Pezzei C, Quadlbauer S, Keuchel T, Jurkowitsch J, Hausner T . Complications after operatively treated distal radius fractures. Arch Orthop Trauma Surg. 2020; 140(5):665-673. DOI: 10.1007/s00402-020-03372-z. View

14.

Berglund L, Messer T . Complications of volar plate fixation for managing distal radius fractures. J Am Acad Orthop Surg. 2009; 17(6):369-77. DOI: 10.5435/00124635-200906000-00005. View

15.

Woolnough T, Axelrod D, Bozzo A, Koziarz A, Koziarz F, Oitment C . What Is the Relative Effectiveness of the Various Surgical Treatment Options for Distal Radius Fractures? A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Clin Orthop Relat Res. 2020; 479(2):348-362. PMC: 7899542. DOI: 10.1097/CORR.0000000000001524. View

16.

Monaco N, Dwyer C, Ferikes A, Lubahn J . Hand Surgeon Reporting of Tendon Rupture Following Distal Radius Volar Plating. Hand (N Y). 2016; 11(3):278-286. PMC: 5030849. DOI: 10.1177/1558944715620792. View

17.

Naito K, Sugiyama Y, Dilokhuttakarn T, Kinoshita M, Goto K, Aritomi K . A survey of extensor pollicis longus tendon injury at the time of distal radius fractures. Injury. 2017; 48(4):925-929. DOI: 10.1016/j.injury.2017.02.033. View

18.

Lans J, Westenberg R, Verhiel S, Garg R, Jupiter J, Chen N . An Economic Analysis of Direct Costs of Distal Radius Fixation and the Implications of a Disposable Distal Radius Kit. J Orthop Trauma. 2021; 35(9):e346-e351. DOI: 10.1097/BOT.0000000000002049. View

19.

Lee J, Lee J, Park J, Kim D, Baek J, Kim Y . Complications associated with volar locking plate fixation for distal radius fractures in 1955 cases: A multicentre retrospective study. Int Orthop. 2020; 44(10):2057-2067. DOI: 10.1007/s00264-020-04673-z. View

20.

Rivlin M, Fernandez D, Nagy L, Grana G, Jupiter J . Extensor Pollicis Longus Ruptures Following Distal Radius Osteotomy Through a Volar Approach. J Hand Surg Am. 2016; 41(3):395-8. DOI: 10.1016/j.jhsa.2015.10.029. View