Rupture of flexor pollicis longus as a complication of Colles' fracture: a case report

Delayed rupture of the flexor tendons as a complication of malunited distal radius fracture after nonoperative management: A report of two cases

Rupture of the flexor tendons is a rare complication following distal radius malunion after nonoperative management. This article presents 2 cases of delayed flexor tendon ruptures following malunited distal radius fracture and discusses the characteristics, operative management, and outcomes of this rare complication by reviewing the previous literature. Our analysis demonstrate that surgical reconstruction of ruptured tendons provides good outcomes when the number of tendon ruptures is small. If multiple tendon ruptures are present, surgical outcomes may be poor despite surgical reconstruction. Osseous surgery would be necessary to prevent additional tendon ruptures; however, less invasive and simple surgeries arrowing early rehabilitation would be preferable.

Acute Isolated Flexor Tendon Laceration Associated With a Distal Radius Fracture

BACKGROUND

Subacute rupture of the flexor tendons secondary to distal radius fractures is well documented. Recently, accounts of flexor tendon rupture following open reduction internal fixation have been associated with volar plate fixation. However, discovery of an occult traumatic flexor tendon laceration during fixation of an acute distal radius fracture is not well described. This case indicates the importance of careful preoperative and intraoperative examination of the flexor tendons in the setting of comminuted distal radius fractures.

METHODS

A forty-seven-year-old male sustained a comminuted, dorsally displaced distal radius fracture. Initial and post-reduction examinations revealed no gross functional abnormalities. Upon operative fixation of the fracture, laceration of the flexor digitorum profundus (FDP) tendon to the index finger was incidentally noted at the level of the fracture site.

RESULTS

Due to extensive dorsal comminution, shortening, and the presence of a lunate facet fragment, we performed volar fragment-specific and dorsal spanning bridge plate fixation. The proximal and distal ends of the FDP tendon were marked, but repair was deferred until implant removal. This allowed for proper informed consent and avoided potential compromise of the repair given the presence of a volar implant.

CONCLUSIONS

Acute flexor tendon rupture secondary to closed distal radius fractures may go unnoticed if a high index of suspicion is not maintained. Delayed diagnosis of these ruptures convolutes the mechanism of injury and disrupts the recovery process. Hand surgeons should be vigilant in examining flexor tendon function during the preoperative evaluation, especially in the setting of acute high-energy injury.

A Simple Clinical Test of Flexor Pollicis Longus Rupture

Rupture of the tendon of flexor pollicis longus is suspected when active flexion of the interphalangeal joint of the thumb is not possible. This can be a result of trauma but, when spontaneous, diagnostic confusion can exist as incomplete palsy of the anterior interosseous nerve can present in a similar way. We describe a simple clinical sign which can differentiate between these conditions.

Delayed rupture of all finger flexor tendons (excluding thumb) following nonoperative treatment of Colles' fracture: A case report and literature review

AIMS

We report a case of delayed all digital flexor tendon ruptures after nonoperative management of distal radius fracture.

METHODS

An 84-year-old woman, noted loss of flexion of your fingers. She had a history of Colles' fracture 40 years before, which had been left untreated. Darrach procedure were carried and a tendon transfers for the flexor tendon ruptures.

RESULTS

Despite attempts of early active mobilisation, a poor operative outcome was observed.

CONCLUSION

Tendon rupture can occur several months or years after the injury, and prompt recognition and treatment can minimize disability.

Bilateral spontaneous rupture of the flexor digitorum superficialis and the flexor digitorum profundus in a diabetic patient

Closed flexor tendon rupture is an unusual condition that has been described in association with distinct underlying disease processes. Several theories have been implicated in the pathogenesis, including labor-associated forceful usage, gender, and age. The effect of diabetes on the native tendon tissue is not yet fully understood; however, the metabolic perturbations of diabetes have been shown to result in detrimental changes to the musculoskeletal system. We report an unusual case of bilateral spontaneous rupture of the flexor digitorum superficialis and flexor digitorum profundus in a 58-year-old woman with Type 2 diabetes mellitus. The clinical course, radiographic findings, and the biomechanical factors and mechanisms through which diabetes may affect the native tendon are presented.

Contribution of flexor pollicis longus to pinch strength: an in vivo study

PURPOSE

To estimate the contribution of the flexor pollicis longus (FPL) to key pinch strength. Secondary outcomes include tip pinch, 3-point chuck pinch, and grip strength.

METHODS

Eleven healthy volunteers consented to participate in the study. We recorded baseline measures for key, 3-point chuck, and tip pinch and for grip strength. In order to control for instability of the interphalangeal (IP) joint after FPL paralysis, pinch measurements were repeated after immobilizing the thumb IP joint. Measures were repeated after subjects underwent electromyography-guided lidocaine blockade of the FPL muscle. Nerve conduction studies and clinical examinations were used to confirm FPL blockade and to rule out median nerve blockade. Paired t-tests were used to compare pre- and postblock means for both unsplinted and splinted measures. The difference in means was used to estimate the contribution of FPL to pinch strength.

RESULTS

All 3 types of pinch strength showed a significant decrease between pre- and postblock measurements. The relative contribution of FPL for each pinch type was 56%, 44%, and 43% for key, chuck, and tip pinch, respectively. Mean grip strength did not decrease significantly. Splinting of the IP joint had no significant effect on pinch measurements.

CONCLUSIONS

FPL paralysis resulted in a statistically significant decrease in pinch strength. IP joint immobilization to simulate IP joint fusion did not affect results.

CLINICAL RELEVANCE

Reconstruction after acute or chronic loss of FPL function should be considered when restoration of pinch strength is important.

Rupture of all digital flexors following Colles' fracture

Flexor tendon rupture following a Colles' fracture is a rare complication with only a handful of cases reported since the initial report in 1932. We present a case in which all digital flexor tendons ruptured within 6 months of a Colles' fracture. Previous reported cases have demonstrated rupture of either the radial or ulnar digital flexors but this case is the first in which all the digital flexors have been involved. This case report highlights the clinical implications of this rare occurrence and stresses the importance of accurate reduction and thorough clinical examination following bony injuries to the wrist.

Closed rupture of both flexor digitorum profundus and superficialis tendons of the small finger in zone II: case report

We report a rare case of closed rupture of both flexor digitorum profundus (FDP) and flexor digitorum superficialis tendons in zone II in the small finger. We performed delayed, primary end-to-end suture of the FDP and excision of the flexor digitorum superficialis, because myostatic contracture of the FDP tendon was not severe and the FDP tendon remnants were not frayed.

Rupture of flexor tendon following volar plate of distal radius fracture. Report of five cases

We report three cases of complete rupture of the flexor pollicis longus (FPL) tendon, one case of complete rupture of the index and middle finger flexor digitorum profundus tendons and one case of rupture of the flexor digitorum profundus tendon to the index finger after placement of a volar plate for distal radius fracture. We review the literature and discuss the aetiology of tendon ruptures and techniques to prevent tendon attition.

Attritional rupture of the flexor tendons to the small finger caused by osteophyte of the ulnar head: case report

We present a rare case of attritional rupture of the flexor tendons to the small finger caused by an osteophyte of the volar aspect of the ulnar head.

Flexor digitorum profundus tendon rupture associated with distal radius fracture malunion: a case report

We present a case of subcutaneous flexor tendon rupture of the index finger following malunion of a distal radius fracture. The cause of the tendon rupture was mechanical attrition due to a bony prominence at the palmar joint rim in the distal radius due to malunion. Corrective osteotomy and the Sauvé-Kapandji procedure were carried out for the wrist pain and forearm rotation disability and a tendon graft was carried out for the flexor tendon rupture. Recovery was satisfactory.

Rupture of the flexor pollicis longus tendon after volar fixed-angle plating of a distal radius fracture: a case report

We report a case of complete rupture of the flexor pollicis longus tendon 13 months after volar fixed-angle plating of a distal radius fracture. Tendon disruption was associated with a prominent distal volar lip of the plate. The plate was placed at the volar distal lip of the radius, at the location recommended by the manufacturer. Most previous reports of flexor tendon ruptures after volar plating of distal radius fractures have been in improperly placed plates, custom-made plates that were later taken off the market, or in physiologically abnormal tendons. This may be a unique case of flexor pollicis longus rupture with a currently commercially available volar fixed-angle plate, placed at the site recommended by the manufacturer, in a patient without other predisposition to tendon rupture.

Flexor carpi radialis tendon rupture as a complication of a closed distal radius fracture: a case report

Although extensor pollicis longus tendon ruptures have been noted as a complication of distal radius fractures, flexor tendon ruptures in association with acute fractures of the distal radius are rare. We report a rupture of the flexor carpi radialis tendon as a complication of an acute distal radius fracture that was discovered during operative management of the fracture.

Rupture de tendons fléchisseurs sur plaque antérieure après fracture du radius distal

We report four cases of flexor tendon ruptures which occurred after distal radial fracture and reviewed the 25 other cases reported in the literature since 1932. Analysis of these 29 cases disclosed the causes of these ruptures. A deformed callus after distal radial fracture or presence of an anterior osteosynthesis plate can under certain conditions lead to secondary flexor tendon tears. It was also found that tears of the flexor pollicis longus rupture predominate, followed by injury to the flexor digitorum profundis and superficialis of the index finger. Other tendons have only been involved in only a few cases. In order to avoid this complication, we propose systematic removal of anterior plates or secondary replacement if the reduction is not totally anatomic. Surgeons should recall the importance of anatomic reduction of distal radial fractures.

Spontaneous rupture of the flexor digitorum profundus and superficialis of the index finger and the flexor pollicis longus without labor-associated tendon loading

Closed ruptures of the flexor tendon have been described in association with distinct underlying pathologies. The spontaneous rupture of the flexor tendon secondary to axial tendon loading alone is infrequent. The previously reported cases with spontaneous rupture were mostly men aged 30 to 60 years. In addition, rupture occurred during manual labor with the fingers engaged in forceful or resisted flexion. Labor-associated forceful usage, in addition to gender and age, has been implicated in the pathogenesis of the stressful rupture of the flexor tendon. Here we report a case with spontaneous rupture of the flexor digitorum profundus (FDP) and superficialis of the index finger as well as the flexor pollicis longus (FPL). Unlike the previously reported cases the present patient was an elderly woman engaged in no apparent occupational activities. In the present case, however, the patient had a particular predisposing condition. The patient used only the right hand during her whole lifetime because of a perinatal brachial plexus injury on the contralateral arm. The present case may show that the tendons of an elderly patient could yield to the axial loading of normal levels of activities of daily living when the usage is as incessant as in the present patient.

Delayed sequential ruptures of the index and thumb flexor tendons due to an occult scaphoid nonunion

A case of sequential spontaneous loss of flexion in the thumb and index finger over a 10 year period is reported. Previously unrecognized carpal collapse as a consequence of a longstanding scaphoid nonunion was identified as the cause. Fusion of the interphalangeal joint of the thumb and suture of the index profundus tendon to the middle profundus tendon resulted in a good outcome.

Attritional flexor tendon ruptures due to distal radius fracture and associated with volar displacement of the distal ulna: a case report

Flexor tendon rupture following distal radius fractures are rare. In this report, a volarly displaced distal ulna that perforated the volar wrist capsule caused delayed flexor tendon ruptures 25 years after a distal radius fracture. The repair with free tendon graft and the excision of the distal ulna produced a successful result.

Attritional rupture of flexor tendons by the head of the ulna associated with a chronic longitudinal radioulnar dissociation

A 62-year-old woman sustained multiple attritional ruptures of the flexor tendons at the wrist caused by displacement of the head of the ulna. She had had injuries of the wrist and elbow when she was young, which were thought to have caused chronic longitudinal radioulnar dissociation with palmar dislocation of the head of the ulna. Attrition of the flexor tendons by the dislocated ulnar head during pronation and supination was the major mechanism for the ruptures in this case. She was successfully treated with tendon transfer and resection of the ulnar head.

Attritional flexor tendon ruptures after a malunited intra-articular fracture of the distal radius

Rupture of the flexor tendon following Colles fracture is uncommon. In all reported cases it occurred as a complication of an extra-articular, displaced fracture of the distal radius. We report a case in which flexor tendon rupture occurred 30 years after a comminuted intra-articular fracture of the distal end of the radius. There have been no reports of delayed flexor tendon rupture after an intra-articular fracture of the distal radius in young adults.

Spontaneous rupture of the flexor pollicis longus tendon on a sesamoid bone

We report a case of rupture of the flexor pollicis longus tendon due to attrition by the ulnar sesamoid bone of the metacarpophalangeal joint of the thumb secondary to osteoarthritic changes of this bone.