PDF(Pubmed)
Abstract：
BACKGROUND: Due to its ability to provide stable fixation and permit early mobilization, volar plating has become the recommended technique for the surgical stabilization of distal radius fractures. The extensor pollicis longus (EPL) tendon may be injured or ruptured as a result of undetected screw penetration or drill plunging. During surgery, it is critical to detect any potential screw penetration so that it can be corrected.
METHODS: A 32-year-old woman presented six weeks post-distal radius plating with an inability to extend her left thumb. Clinical examination revealed loss of extension at the interphalangeal joint, stiff wrist, tender point over the dorsal aspect of the wrist, and an intact sensory nerve function.
CONCLUSIONS: Dynamic ultrasound and magnetic resonance imaging (MRI) both revealed no evidence of tendon rupture or EPL tendon movement. X-rays revealed the distal epiphyseal screws penetrating the far cortex. Intraoperatively, the EPL tendon was found to be impinged by a screw. The tendon was released, tenolysis was performed, and the distal screws were shortened.
CONCLUSIONS: In order to assess screw penetration into the far cortex, volar plating for distal radius fractures should be performed using intraoperative imaging views such as lateral, 45-degree supination, 45-degree pronation, dorsal tangential, and skyline views. Timely interventions after distal radius fracture fixation preserve tendon function, and early detection of tendon compromise is essential to preventing additional damage.
METHODS: A 32-year-old woman presented six weeks post-distal radius plating with an inability to extend her left thumb. Clinical examination revealed loss of extension at the interphalangeal joint, stiff wrist, tender point over the dorsal aspect of the wrist, and an intact sensory nerve function.
CONCLUSIONS: Dynamic ultrasound and magnetic resonance imaging (MRI) both revealed no evidence of tendon rupture or EPL tendon movement. X-rays revealed the distal epiphyseal screws penetrating the far cortex. Intraoperatively, the EPL tendon was found to be impinged by a screw. The tendon was released, tenolysis was performed, and the distal screws were shortened.
CONCLUSIONS: In order to assess screw penetration into the far cortex, volar plating for distal radius fractures should be performed using intraoperative imaging views such as lateral, 45-degree supination, 45-degree pronation, dorsal tangential, and skyline views. Timely interventions after distal radius fracture fixation preserve tendon function, and early detection of tendon compromise is essential to preventing additional damage.
摘要：
背景：由于其能够提供稳定的固定并允许早期动员的能力，掌侧钢板已成为桡骨远端骨折手术稳定的推荐技术。由于未检测到的螺钉穿刺或钻孔插入，长伸肌（EPL）肌腱可能会受伤或破裂。手术期间,它是至关重要的检测任何潜在的螺旋渗透，以便它可以被纠正。
方法：一名32岁的女性在桡骨远端钢板术后6周表现为无法伸出左手拇指。临床检查显示指间关节伸展丧失，僵硬的手腕，手腕背侧的压痛点，和完整的感觉神经功能。
结论：动态超声和磁共振成像（MRI）均未发现肌腱断裂或EPL肌腱运动的证据。X射线显示远端骨phy螺钉穿透了远皮质。术中,发现EPL肌腱被螺钉撞击。肌腱被释放,进行了肌腱溶解，远端螺钉缩短。
结论：为了评估螺钉向远皮质的渗透，桡骨远端骨折的掌侧钢板应使用术中成像视图进行，例如外侧，45度仰卧起坐,45度内旋,背侧相切,和天际线视图。桡骨远端骨折固定术后及时干预保留肌腱功能，早期发现肌腱受损对防止额外损伤至关重要。
方法：一名32岁的女性在桡骨远端钢板术后6周表现为无法伸出左手拇指。临床检查显示指间关节伸展丧失，僵硬的手腕，手腕背侧的压痛点，和完整的感觉神经功能。
结论：动态超声和磁共振成像（MRI）均未发现肌腱断裂或EPL肌腱运动的证据。X射线显示远端骨phy螺钉穿透了远皮质。术中,发现EPL肌腱被螺钉撞击。肌腱被释放,进行了肌腱溶解，远端螺钉缩短。
结论：为了评估螺钉向远皮质的渗透，桡骨远端骨折的掌侧钢板应使用术中成像视图进行，例如外侧，45度仰卧起坐,45度内旋,背侧相切,和天际线视图。桡骨远端骨折固定术后及时干预保留肌腱功能，早期发现肌腱受损对防止额外损伤至关重要。
