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

Brooker B, Harris PC, Donnan LT, Graham HK - J Child Orthop (2014)

Bottom Line: In many of the cases the EPL dysfunction occurred early on but it's recognition was often delayed.Based 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.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Department, The Royal Children's Hospital, Flemington Road, Parkville, Melbourne, VIC, 3052, Australia.

ABSTRACT

Introduction: Diaphyseal 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 methods: We report a series of nine patients who sustained an EPL injury related to the insertion of an elastic intramedullary nail into the radius.

Results: All 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.

Conclusion: Based 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.

No MeSH data available.


Related in: MedlinePlus

Anteroposterior and lateral radiographs representing the typical nail entry sites for all cases
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Related In: Results  -  Collection


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Fig1: Anteroposterior and lateral radiographs representing the typical nail entry sites for all cases

Mentions: Over a 5-year period (December 2008 to July 2013), nine cases with delayed rupture or dysfunction of the EPL following intramedullary nailing of forearm fractures in paediatric patients were identified. Patients were referred from a number of hospitals in the metropolitan area to a paediatric tertiary care centre. All patients had displaced diaphyseal fractures of the radius and ulna. In each case, the initial surgeon had inserted the radial nail in a percutaneous manner; they had identified the entry level using fluoroscopy, made a small dorsal skin incision (approximately 5 mm) over Lister’s tubercle, performed blunt dissection down to bone and used an awl to make the entry point, without visualisation of the extensor tendons. Standard approaches had been used, both for open fractures and for those requiring open reduction. The nails had been cut short, just below skin level, to permit later removal (Fig. 1). The incisions were closed with a single absorbable suture and the upper limb immobilised in an above-elbow plaster cast. Patients were admitted to hospital for elevation and neurovascular observation, and were typically discharged the following day.Fig. 1


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

Brooker B, Harris PC, Donnan LT, Graham HK - J Child Orthop (2014)

Anteroposterior and lateral radiographs representing the typical nail entry sites for all cases
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4128948&req=5

Fig1: Anteroposterior and lateral radiographs representing the typical nail entry sites for all cases
Mentions: Over a 5-year period (December 2008 to July 2013), nine cases with delayed rupture or dysfunction of the EPL following intramedullary nailing of forearm fractures in paediatric patients were identified. Patients were referred from a number of hospitals in the metropolitan area to a paediatric tertiary care centre. All patients had displaced diaphyseal fractures of the radius and ulna. In each case, the initial surgeon had inserted the radial nail in a percutaneous manner; they had identified the entry level using fluoroscopy, made a small dorsal skin incision (approximately 5 mm) over Lister’s tubercle, performed blunt dissection down to bone and used an awl to make the entry point, without visualisation of the extensor tendons. Standard approaches had been used, both for open fractures and for those requiring open reduction. The nails had been cut short, just below skin level, to permit later removal (Fig. 1). The incisions were closed with a single absorbable suture and the upper limb immobilised in an above-elbow plaster cast. Patients were admitted to hospital for elevation and neurovascular observation, and were typically discharged the following day.Fig. 1

Bottom Line: In many of the cases the EPL dysfunction occurred early on but it's recognition was often delayed.Based 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.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Department, The Royal Children's Hospital, Flemington Road, Parkville, Melbourne, VIC, 3052, Australia.

ABSTRACT

Introduction: Diaphyseal 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 methods: We report a series of nine patients who sustained an EPL injury related to the insertion of an elastic intramedullary nail into the radius.

Results: All 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.

Conclusion: Based 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.

No MeSH data available.


Related in: MedlinePlus