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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

Case 7: EPL tendon compressed under nail
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Fig2: Case 7: EPL tendon compressed under nail

Mentions: All patients underwent operative management. In three patients, the EPL tendon was intact but trapped (compressed) by the end of the nail, where it exited from the bone. Decompression was performed in one patient by bending the nail end away from the tendon, allowing it to glide freely (Fig. 2). In two other patients, the nail was removed and the EPL tendon released. EPL function rapidly returned to normal in these three patients. In the other six patients. there was complete rupture of the EPL tendon, which was treated by extensor indicis proprius transfer in four patients and direct EPL repair in two patients. Nails were removed at the same time (Fig. 3). The reconstruction or repair was protected by casting with the thumb extended for 4–6 weeks, followed by rehabilitation exercises, supervised by a hand therapist. The functional outcomes were good at a mean follow up of 14 months.Fig. 2


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)

Case 7: EPL tendon compressed under nail
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: Case 7: EPL tendon compressed under nail
Mentions: All patients underwent operative management. In three patients, the EPL tendon was intact but trapped (compressed) by the end of the nail, where it exited from the bone. Decompression was performed in one patient by bending the nail end away from the tendon, allowing it to glide freely (Fig. 2). In two other patients, the nail was removed and the EPL tendon released. EPL function rapidly returned to normal in these three patients. In the other six patients. there was complete rupture of the EPL tendon, which was treated by extensor indicis proprius transfer in four patients and direct EPL repair in two patients. Nails were removed at the same time (Fig. 3). The reconstruction or repair was protected by casting with the thumb extended for 4–6 weeks, followed by rehabilitation exercises, supervised by a hand therapist. The functional outcomes were good at a mean follow up of 14 months.Fig. 2

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