Arch Hand Microsurg.  2022 Dec;27(4):315-319. 10.12790/ahm.22.0053.

Rupture of the extensor carpi radialis longus and extensor carpi radialis brevis tendons following conservative treatment of a distal radius fracture: a case report

• Choi S
• Lee J
• Lee CR
• Lee Y
• Yu JS

• KMID: 2536219
• DOI: http://doi.org/10.12790/ahm.22.0053

Abstract

Conservative treatment shows favorable results for minimally displaced fractures of the distal radius. A commonly reported complication associated with distal radius fractures is delayed tendon rupture. The extensor pollicis longus tendon is the tendon that has most commonly been reported to be injured in distal radius fractures. This report provides a new case of delayed rupture of the extensor carpi radialis longus and extensor carpi radialis brevis tendons after conservative treatment of a distal radius fracture, along with a review of the literature.

Keyword

Distal radius fracture; Conservative treatment; Extensor rupture; Extensor carpi radialis longus; Extensor carpi radialis brevis

Figure

• 

  Fig. 1. Plain radiographs of the left wrist. (A) Posterior anterior view and (B) lateral view. A decreased volar tilt angle was seen on the lateral view.

• 

  Fig. 2. Transverse ultrasonography image shows a well-circumscribed, hypoechoic mass (arrow) on the dorsum of the second and third metacarpal bases.

• 

  Fig. 3. Intraoperative photograph of the first operation planned for mass excision. The mass was the remnant of the ruptured extensor carpi radialis longus and extensor carpi radialis brevis tendons.

• 

  Fig. 4. Magnetic resonance imaging obtained after the first operation. The images revealed a large osteophyte (arrows) sharply protruding into the second extensor compartment in (A) the coronary plane and (B) axial plane.

• 

  Fig. 5. The proximal ends of the ruptured extensor carpi radialis longus and extensor carpi radialis brevis tendons were identified with intact sheaths.

• 

  Fig. 6. Tendon reconstruction of the extensor carpi radialis longus and extensor carpi radialis brevis was performed with autologous palmaris longus tendon obtained from both forearms.

• 

  Fig. 7. (A) A clinical photograph shows a limited extension of the left wrist with less motor power than the right wrist. (B) Six weeks postoperatively, nearly a full range of extension and motor power was found.

Reference

References

1. Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012; 28:113–25.

2. McKay SD, MacDermid JC, Roth JH, Richards RS. Assessment of complications of distal radius fractures and development of a complication checklist. J Hand Surg Am. 2001; 26:916–22.

3. Schaller P, Baer W, Carl HD. Extensor indicis-transfer compared with palmaris longus transplantation in reconstruction of extensor pollicis longus tendon: a retrospective study. Scand J Plast Reconstr Surg Hand Surg. 2007; 41:33–5.

4. Roth KM, Blazar PE, Earp BE, Han R, Leung A. Incidence of extensor pollicis longus tendon rupture after nondisplaced distal radius fractures. J Hand Surg Am. 2012; 37:942–7.

5. Sadr B. Sequential rupture of extensor tendons after a Colles’ fracture. Plast Reconstr Surg. 1985; 76:487.

6. de Boer SW, van Kooten EO, Ritt MJ. Extensor pollicis longus tendon rupture with concomitant rupture of the extensor digitorum communis II tendon after distal radius fracture. J Hand Surg Eur Vol. 2010; 35:679–81.

7. Hirasawa Y, Katsumi Y, Akiyoshi T, Tamai K, Tokioka T. Clinical and microangiographic studies on rupture of the E.P.L. tendon after distal radial fractures. J Hand Surg Br. 1990; 15:51–7.

8. Komura S, Hirakawa A, Yamamoto K, et al. Delayed rupture of the flexor tendons as a complication of malunited distal radius fracture after nonoperative management: a report of two cases. Trauma Case Rep. 2019; 21:100198.

9. Vandeputte G, De Smet L. Avulsion of both extensor carpi radialis tendons: a case report. J Hand Surg Am. 1999; 24:1286–8.

10. Mundell T, Miladore N, Ruiter T. Extensor carpi radialis longus and brevis rupture in a boxer. Eplasty. 2014; 14:ic40.