title: Multiple ruptures of the extensor tendons after volar fixation for distal radius fracture: a case report.
abstract: A 62-year-old woman was admitted to our hospital after a bicycle accident with a displaced left (non-dominant) distal radius fracture. After closed reduction a long cast was applied. Due to loss of reduction, twenty-four days later open reduction internal fixation with locking compression plate (LCP) was performed. The patient returned to her normal activities but nineteen months after surgery showed functional impairment of the left thumb for Extensor Pollicis Longus (EPL) injury for which she necessitated transposition surgery. Twenty-six months after ORIF, functional deficit of the extension of the third and fourth left finger was noted secondary to injury of extensor tendons. Ultrasound and CT scan showed protrusion of the angular stability screws in LCP plate that caused a progressive wear resulting in rupture of the extensor tendons. Another tendon transposition surgery was performed with dorsal approach while the plate was removed utilising the original volar incision. Reconstruction of distal radius fractures with volar plating, requires accurate plate application with precise measurement of the length of the screws in order to prevent dorsal protrusion and thus avoiding tendon injuries.
authors.affiliation: Health Firm Hand, Palagi Hospital (I.O.T.), Florence, Italy. Electronic address: giancarlo.caruso@asf.toscana.it.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Caruso
authors.affiliation: Health Firm Hand, Palagi Hospital (I.O.T.), Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vitali
authors.affiliation: Department of Orthopaedic and Traumatology, S.G.D. Hospital, Florence, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: del Prete
mesh_terms: D000063:Accidents, Traffic; D001860:Bone Plates / Q000009:adverse effects*; D001863:Bone Screws / Q000009:adverse effects; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008875:Middle Aged; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function; D012421:Rupture / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013165:Splints; D013708:Tendon Injuries / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology*
keywords: fractures of distal radius; open reduction internal fixation (ORIF); ruptures of tendons; secondary displacement; tendon transfer