Supernumerary extensor pollicis longus tendon masking an extensor pollicis longus rupture following non-surgical treatment of a distal radius fracture

Extensor pollicis longus tendon pathology is a recognised complication following non-surgical treatment of non-displaced distal radius fractures. Tendon entrapment typically presents with pain, but preservation of thumb retropulsion during complete rupture results in loss of active thumb retropulsion and tenodesis effect. We present the case of a 52-year-old woman who developed extensor pollicis longus tendon entrapment with full active thumb extension following a non-displaced distal radius fracture. During her elective third dorsal compartment release, the extensor pollicis longus tendon was found to be completely ruptured and a rare supernumerary extensor pollicis longus tendon was found emerging from the fourth dorsal compartment. Gentle traction of this tendon resulted in thumb interphalangeal joint extension and simultaneous index finger metacarpophalangeal joint extension. An extensor indicis proprius to extensor pollicis longus tendon transfer was performed. At her final 6-month follow-up, she had painless full active thumb motion comparable to her contralateral side.

“One Note Higher”: A Unique Pediatric Hand Fracture

Case Presentation: An otherwise healthy, 12-year-old male presented to the emergency department after a fall down the stairs in which he landed on his right hand. Radiographs demonstrated a Salter-Harris II fracture at the base of the proximal phalanx of the fifth digit with ulnar deviation, also known as an “extra-octave“ fracture. Orthopedic surgery was consulted and the fracture was reduced and placed in a short-arm cast. The patient was discharged and scheduled for orthopedic follow-up. Discussion: A Salter-Harris II fracture at the base of the proximal phalanx of the fifth digit with ulnar deviation is referred to as an “extra-octave” fracture due to the advantage a pianist would gain in reach of their fifth phalanx if not reduced. However, reduction is needed if the fracture is displaced and can be achieved by several described methods including the “90-90” or “pencil” methods followed by cast or splint application. Percutaneous pinning is rarely needed. Complications include flexor tendon entrapment, collateral ligament disruption, and malunion leading to a “pseudo-claw” deformity. We recommend that all extra-octave fractures receive orthopedic follow-up in one to two weeks or sooner if severely displaced.

Hawkins type III talar neck fracture dislocation with neurovascular and tendon entrapment in a toddler

Paediatric displaced fracture of the neck of talus is extremely rare injury with variable outcomes. We report our experience in managing a Hawkins type III talar neck fracture dislocation with neurovascular and tendon entrapment in a 3-year-old boy. We describe the emergency presentation, radiological findings, orthopaedic management and clinical and functional outcomes in this toddler following the injury with review of the current literature.

Successful reconstruction of distal peroneus longus tendon dislocation associated with a split lesion – a case report

Background Peroneal tendon injuries are one of the differential diagnoses in lateral ankle and rearfoot pain. While partial tears are not uncommon, peroneal tendon dislocation at the peroneal tubercle is very rare. Until now, only three papers have been published, presenting five cases of peroneus longus tendon dislocation over the peroneal tubercle. This report adds a previously undescribed case of a peroneus longus tendon split tear that was partially dislocated and entrapped over the peroneal tubercle. The respective operative approach and the outcome are described. Case presentation A 25-year-old international top-level speed skater developed a painful mass over the lateral calcaneal wall. There was no specific inducing injury in his medical history. In contrast to previous reports, according to the patient’s history, a snapping phenomenon was not present. Conservative treatment was not effective. By inspection and palpation an enlarged peroneal tubercle was assumed. During operative exploration, we found an incomplete longitudinal split tear of the peroneus longus tendon, which was partially dislocated and entrapped over the peroneal tubercle. This mimicked an enlarged peroneal tubercle. A portion of the split tendon was resected. A deepening procedure of the flat groove of the peroneus longus tendon below the peroneal tubercle and a transosseous reconstruction of the avulsed inferior peroneal retinaculum were performed. After six months, the patient had completely reintegrated into his elite sport and has been free of symptoms since then. Conclusions From the presented case it can be speculated that the inferior peroneal retinaculum was overused, worn out, detached, or ruptured due to overpronation and friction the lateral edge of the low-cut speed skating shoe. Then the peroneus longus tendon experienced substantial friction with the peroneal tubercle with possible dislocation during ankle motion. This frictional contact may have finally led to further degeneration and a longitudinal tear of the tendon. Obviously, dislocations can develop insidiously resulting in lesions of the peroneus longus tendon at the peroneal tubercle, ultimately leading to a tendon entrapment. This mimics an enlarged tubercle. The pathology is very rare and can be successfully addressed surgically.

Extensor Tendon Entrapment on Computed Tomography Imaging of Distal Radius Fractures

Objective To examine the association between distal radius fractures and tendon entrapment identified on computed tomography (CT) imaging. Patients and Methods After Institutional Review Board approval, we retrospectively reviewed distal radius fractures that underwent CT imaging from an electronic database between January 2006 to February 2018 at a single level 1 hospital trauma center. We categorized all distal radial fractures according to the AO-OTA (AO Foundation/Orthopaedic Trauma Association) classification. Distal upper extremity tendons were assessed for entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. Results A total of 183 distal radius fractures were identified in 179 patients. A total of 16 fractures (13 males and 3 females) were associated with tendon entrapment. Mechanism of injury included falls (n = 7), motor vehicle accidents (n = 6), dog bites (n = 2), and gunshot wound (n = 1). Entrapped tendons were limited to the extensor compartment and included the extensor pollicis longus (EPL; n = 11), extensor pollicis brevis (n = 1), extensor carpi ulnaris (n = 1), extensor carpi radialis longus (n = 1), and extensor digitorum communis (n = 2). The most commonly associated AO-OTA fracture pattern with tendon entrapment was complete articular radial fractures (2R3C; 69%), eight of which were simple articular with metaphyseal multifragmentary fractures (2R3C2). Of the distal radius fractures, 81% were associated with additional ulnar fractures of varying severity and displacement. Conclusion Approximately 8.7% of distal radius fractures were retrospectively identified to have tendon entrapment compared with a previously reported incidence of 1.3%. Wrist surgeons and radiologists should have higher suspicion for tendon entrapment and carefully review preoperative CT imaging for tendon entrapment in distal radius fractures especially if there is an intra-articular, multifragmentary injury pattern. Wrist surgeons and radiologists should also have increased suspicion for EPL tendon entrapments given its high incidence in association with distal radius fractures. Level of Evidence This is a Level III, retrospective cross-sectional study.