Diagnostic ultrasound of tendon injuries in the setting of distal radius fractures

Tendon Anatomy and Tendon Disorders of the Wrist

Wrist pain is common and can be attributed to tendon pathologies.This review aims to give a structured review of tendon anatomy, discuss anatomical pitfalls, and provide an overview of typical tendon pathologies of the wrist based on the current literature.Typical tendon pathologies of the wrist include de Quervain tenosynovitis, proximal and distal intersection syndrome, extensor and flexor pollicis longus tendon ruptures, and extensor carpi ulnaris subsheath injury. Typical pitfalls are multiple bundles of the abductor pollicis longus tendon or the centrally increased signal of the extensor carpi ulnaris tendon.Both ultrasound and MRI are appropriate modalities for assessing the tendons of the wrist. Knowledge of normal anatomy, variants, pathologies, as well as appropriate imaging is crucial to determine the diagnosis. · Multiple tendon bundles of the abductor pollicis longus are a common anatomical feature and should not be mistaken for tendon splitting.. · An anatomical pitfall resembles the frequently found centrally increased signal of the extensor carpi ulnaris tendon caused by fibrovascular tissue.. · In order to visualize the diagnosis of a proximal intersection syndrome, the MR scan field needs to include the area approximately 4 to 8 cm proximal to Lister's tubercle.. · The tendons of the thumb, i.e., extensor and flexor pollicis longus, are most commonly torn after distal radial fracture (EPL) and osseous hardware fixation (FPL).. · Marth T, Grob NA, Jacobson JA et al. Tendon Anatomy and Tendon Disorders of the Wrist. Rofo 2025; DOI 10.1055/a-2499-5875.

The use of ultrasound to predict flexor tendinopathy after anterior locking plating of the distal radius

This study compares ultrasound to clinical and radiographic measurements for assessing tendon pathology associated with distal radial anterior locking plates. A total of 46 patients undergoing removal of a distal radial plate had a preoperative clinical examination, radiographs and ultrasound evaluation to detect evidence of tendon irritation. Gross changes to the tendon were assessed during plate removal. In total, 32 patients demonstrated clinical abnormality. Soong 2 position was noted in 13 patients. Ultrasound revealed tenosynovitis in nine patients, tendon fibrillation or thickening in four patients and a single case of partial discontinuity. Intraoperative assessment revealed tenosynovitis in 28 patients and tendon fibre discontinuity in eight patients. Ultrasound findings were not predictive of intraoperative tenosynovitis and discontinuity. A relationship was noted between higher Soong grade, especially grade 2, and intraoperative presence of tenosynovitis, as well as Soong grade and amount of soft-tissue coverage. This study negates our hypothesis that ultrasound is useful for identifying tendinopathy after distal radial anterior plate fixation.Level of evidence: II.

Cause of Extensor Pollicis Longus Ruptures After Distal Radius Fracture Fixation Using a Volar Plate

BACKGROUND

This research sought to analyze a cohort of patients with extensor pollicis longus (EPL) ruptures after volar locked plating of a distal radius fracture (DRF) to characterize the incidence of ruptures that are unlikely to be related to dorsal screw prominence.

METHODS

This is a retrospective, observational, descriptive cohort study of adults with operative fixation of a closed DRF and an EPL rupture between 2002 and 2022. Eighteen patients with operative fixation using a volar plate of a closed DRF had an EPL rupture. The cohort consisted of 66% women with an average age of 57.5 years. Median follow-up was 14.5 months.

RESULTS

The incidence of EPL rupture was 0.4% (18/4768). The average time from DRF and DRF fixation to EPL rupture was 3.7 and 3.4 months, respectively. Based on the operative record, in 2 of the 18 patients (11%), the rupture was directly attributable to prominent hardware; however, in 4 of the 18 patients (22%), the rupture was not related to prominent hardware, and the cause was indeterminate in 12 patients (67%). Radiologic analysis of those in the indeterminate group demonstrated that 5 of the 12 patients had screws that had a high probability of being prominent.

CONCLUSIONS

The incidence of EPL rupture after volar plating of DRF is between 0% and 1% and usually occurs about 3 months after fixation. Approximately 50% of EPL ruptures are attributable to prominent dorsal screws. Although screw prominence is an important cause of EPL rupture, it is not the sole cause of rupture.

Ultrasound and Nanomedicine for Cancer-Targeted Drug Delivery: Screening, Cellular Mechanisms and Therapeutic Opportunities

Cancer is a disease characterized by abnormal cell growth. According to a report published by the World Health Organization (WHO), cancer is the second leading cause of death globally, responsible for an estimated 9.6 million deaths in 2018. It should be noted that ultrasound is already widely used as a diagnostic procedure for detecting tumorigenesis. In addition, ultrasound energy can also be utilized effectively for treating cancer. By filling the interior of lipospheres with gas molecules, these particles can serve both as contrast agents for ultrasonic imaging and as delivery systems for drugs such as microbubbles and nanobubbles. Therefore, this review aims to describe the nanoparticle-assisted drug delivery system and how it can enhance image analysis and biomedicine. The formation characteristics of nanoparticles indicate that they will accumulate at the tumor site upon ultrasonic imaging, in accordance with their modification characteristics. As a result of changing the accumulation of materials, it is possible to examine the results by comparing images of other tumor cell lines. It is also possible to investigate ultrasound images for evidence of cellular effects. In combination with a precision ultrasound imaging system, drug-carrying lipospheres can precisely track tumor tissue and deliver drugs to tumor cells to enhance the ability of this nanocomposite to treat cancer.