Presentation
Painful left wrist post fall
Patient Data
An acute minimally displaced fracture traverses the distal left radius, with the main fracture lines parallel to the articular surface of the wrist joint. Distal articular is mildly dorsally angulated ~100. The wrist joint is enlocated.
Two corticated bony fragments are demonstrated adjacent to the distal ulna, widening the medial wrist joint space. The larger measures 7 mm and the smaller 2 mm. These are in keeping with an old injury.
There is increasing sclerosis at the transverse fracture line of the distal radius and early callus formation consistent with healing. Callus formation is more prominent dorsally.
Thin longitudinal component to the fracture is also noted. Previous avulsion injury of the ulnar styloid.
Rupture of the extensor pollicis longus tendon. First 2 images of the series best show thickening of the tendon sheath with absence of tendon fibers and increased vascularity. Compare these images with the normal extensor indicis in the following images.
Ultrasound survey along the extensor indicis tendon (Images 3-7) shows the tendon is intact and normal throughout its length.
Case Discussion
Extensor pollicis longus tendon rupture occurs in 0.2-3% of distal radial fractures 3, often without any warning symptoms. It is said to occur more commonly in undisplaced fractures where the extensor retinaculum remains in tact so that the tendon is tightly held against the bone and at risk of abrasian against fracture callus1.
It may also occur in the presence of fracture spikes or where there is impingement against fixation devices. Others have postulated tendon ischemia secondary to injury as a cause2.
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