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

Area of Science:

• Orthopedic Surgery
• Radiology
• Hand Surgery

Background:

• Extensor pollicis longus (EPL) rupture is a known complication following volar plate fixation for distal radius fractures.
• Prominent dorsal screw tips are often implicated, but may not be the sole cause of EPL rupture.
• Preoperative assessment of EPL integrity at the time of injury is crucial.

Purpose of the Study:

• To evaluate preoperative computed tomography (CT) scans of distal radius fractures.
• To characterize the incidence of EPL damage at the time of injury.
• To identify potential causes of EPL rupture beyond prominent screw tips.

Main Methods:

• Retrospective study of adult patients with operatively treated distal radius fractures.
• Inclusion criteria: preoperative CT scan within 2 weeks of injury.
• 96 wrists in 95 patients analyzed, with a median follow-up of 56 months.

Main Results:

• 75% of fractures involved Lister's tubercle.
• 18% of these fractures had the EPL tendon entrapped by fragments.
• Only two cases of EPL injury were clinically apparent in the cohort.

Conclusions:

• Not all EPL ruptures post-distal radius fracture fixation are due to prominent dorsal screws.
• Entrapment of the EPL tendon within Lister's tubercle fracture fragments is a frequent occurrence.
• Preoperative CT evaluation of the EPL's relationship with Lister's tubercle can help assess rupture risk.