Rupture of all the flexor tendons in the hand due to malunion of a distal radius fracture

Acute carpal tunnel syndrome after atraumatic rupture of the flexor tendons: a case report

Acute carpal tunnel syndrome (ACTS) is a rare entity, mainly associated with traumatic causes, although patients with predisposing factors such as taking anticoagulants or tendinopathies may debut with an atraumatic ACTS. This case study presents the case of a 77-year-old male patient, anticoagulated, who began with rapidly progressive pain and swelling in the right wrist, radiating towards the medial territory, with no history of traumatic triggering event. Examination showed paraesthesia in the volar aspect of the first to third fingers of the hand and increased pain on passive mobilisation of the fingers. Given the progressive evolution of the condition and the lack of response to both physical and pharmacological measures, the carpal tunnel was opened surgically. During surgery, a significant haematoma was observed secondary to the rupture of the deep flexor tendons of the fourth and fifth fingers inside the canal. Following release of the carpal tunnel, complete recovery of the symptomatology occurred. In conclusion, a high degree of clinical suspicion is necessary in a patient with an examination suggestive of ACTS. The treatment of choice is urgent surgical decompression of the carpal tunnel. Early intervention allows resolution of symptoms and reduces complications.

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.

Five-decade-delayed closed flexor tendon rupture due to Galeazzi dislocation fracture associated with Behçet syndrome: A case report

INTRODUCTION

Closed flexor tendon rupture after a malunited distal radius fracture is rare and usually becomes apparent early after the fracture. Most cases are accompanied by a severe distal radio-ulnar joint capsule injury, wherein bone protrusion (as a spur) directly stresses the tendons. We experienced a nonspecific flexor tendon rupture associated with an old fracture and the presence of collagen disease.

PRESENTATION OF CASE

A 63-year-old woman presented with delayed complete rupture of the flexor digitorum profundus (FDP) of the fifth digit. Her history included closed fracture on the left wrist at age 13 years. At 27 years, she was diagnosed with Behçet syndrome and commenced oral prednisolone 10 mg/day. At the current admission, physical examination revealed that she was incapable of fifth finger flexion after minor passive extension. The fifth digit FDP rupture appeared to be due to damage at the wrist-level fracture site. A tiny capsule rupture was seen on the volar side of the distal radio-ulnar joint. We resected ulnar head osteophytes protruding from the capsule hole and transferred tendon from the fifth FDP to the fourth FDP.

CONCLUSION

Reportedly, metalloproteases weaken tendon structure by acting as a collagenase in patients with Behçet syndrome. Also, vasculitis next to a tendon and steroid intake are considered to impede the tendon repair process. Hence, even minor trauma may lead to complete tendon rupture. Although an injury seems slight, we should take into account the possible history of bone and joint trauma.

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.

Danger zones for flexor tendons in volar plating of distal radius fractures

PURPOSE

To define a danger zone for volar plates using magnetic resonance imaging by analyzing the position of the flexor tendons at risk around the watershed line.

METHODS

We analyzed 40 wrist magnetic resonance images. The location of the flexor pollicus longus (FPL) and index flexor digitorum profundus (FDPi) tendons was recorded at 3 and 6 mm proximal to the watershed line of the distal radius. We measured the distance between the volar margin of the distal radius and the FPL and FDPi tendons, and the coronal position of the tendons.

RESULTS

At a point 3 mm proximal to the watershed line, FPL and FDPi were located on average 2.6 and 2.2 mm anterior to the volar margin of the distal radius. This distance increased to 4.7 and 5.3 mm at a point 6 mm proximal to the watershed line. The FPL and FDPi were located at 57% and 42% of the total width of the distal radius from the sigmoid notch at 3 mm from the watershed, and at 66% and 46% at 6 mm from the watershed.

CONCLUSIONS

Surgeons should be aware of the close proximity of the flexor tendons to the volar cortex of the distal radius proximal to the watershed line and their radial to ulnar position. Three millimeters proximal to the watershed line, plate placement more than 2 mm anterior to the volar cortex or the use of plates thicker than 2 mm poses a high risk for directly contacting flexor tendons.

CLINICAL RELEVANCE

This article may prove to be helpful in avoiding flexor tendon injury during volar plate fixation.

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.

Zone 2 flexor digitorum profundus and superficialis rupture treated with single-stage tendon reconstruction using an Active Hunter Rod Implant

To our knowledge, no report has been published of a flexor tendon rupture as a result of a closed phalangeal fracture.A 58-year-old woman with multiple medical comorbidities presented with a closed, apex volar fracture of her long finger proximal phalynx with clinically intact flexor digitorum profundus and superficialis tendons in zone 2 of the flexor tendon sheath. After 5 weeks of nonoperative treatment, the patient reported hearing a pop in her finger, and clinical findings suggested rupture of the flexor digitorum profundus and superficialis tendons. Intraoperatively, the nonreparable attritional rupture was underneath the A2 pulley. A bony prominence in the tendon sheath floor from the healed phalynx fracture made rerupture a concern with a tendon graft. A Hunter Active Tendon Implant (Wright Medical Technology, Inc, Arlington, Tennessee) was used to reconstruct the flexor digitorum profundus tendon to avoid a second procedure. The patient progressed well and had regained a functional arc of active finger range of motion by 2 months postoperatively.The Hunter Active Tendon Implant provided a suitable alternative to a 2-staged procedure, with the added benefit that a good tendon bed was developed in the event that a second procedure was needed.

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.

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.