Medicine · 2025
Restricted thumb extension due to flexor pollicis longus tendon adhesion following volar plate fixation with bone substitute use for distal radius fracture: A case report and literature review.
СтатьяКлинический случайОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Roh Youn-Tae, Wang Chia Jan, Park Il-Jung
Аннотация
RATIONALE: Tendon adhesion is a relatively uncommon complication after distal radius fracture surgery.
PATIENT CONCERNS: A 51-year-old woman underwent open reduction and volar plate fixation for a distal radius fracture at another hospital approximately 4 weeks ago. Upon presentation to our hospital, active flexion of the thumb interphalangeal (IP) joint was preserved, but active extension was absent; additionally, passive extension of the thumb IP joint could not be achieved by the examiner.
DIAGNOSES: Plain radiography and computed tomography demonstrated that 1 distal screw of the volar plate protruded beyond the dorsal cortex, with radiopaque material visible on the radial-volar aspect of the plate. Although rupture of the extensor pollicis longus tendon by the protruding screw was considered, passive extension of the thumb IP joint is generally preserved in such cases. Therefore, adhesion of the flexor pollicis longus tendon was considered more likely than extensor pollicis longus tendon rupture.
INTERVENTIONS: Surgical exploration confirmed severe adhesion of the flexor pollicis longus to the volar plate, which was released via adhesiolysis. And remnants of the demineralized bone matrix and hydroxyapatite complex previously applied were identified and removed.
OUTCOMES: Early initiation of both active and passive rehabilitation was implemented postoperatively without immobilization. At 4 years postoperatively, the patient demonstrated full active extension of the thumb IP joint, with no evidence of recurrence.
LESSONS: When using bone graft substitutes containing demineralized bone matrix or bone morphogenetic proteins, measures should be taken to prevent leakage into adjacent soft tissues, particularly in regions containing multiple tendons. In addition, any leaked bone graft substitute should be removed using techniques such as irrigation at the surgical site.
PATIENT CONCERNS: A 51-year-old woman underwent open reduction and volar plate fixation for a distal radius fracture at another hospital approximately 4 weeks ago. Upon presentation to our hospital, active flexion of the thumb interphalangeal (IP) joint was preserved, but active extension was absent; additionally, passive extension of the thumb IP joint could not be achieved by the examiner.
DIAGNOSES: Plain radiography and computed tomography demonstrated that 1 distal screw of the volar plate protruded beyond the dorsal cortex, with radiopaque material visible on the radial-volar aspect of the plate. Although rupture of the extensor pollicis longus tendon by the protruding screw was considered, passive extension of the thumb IP joint is generally preserved in such cases. Therefore, adhesion of the flexor pollicis longus tendon was considered more likely than extensor pollicis longus tendon rupture.
INTERVENTIONS: Surgical exploration confirmed severe adhesion of the flexor pollicis longus to the volar plate, which was released via adhesiolysis. And remnants of the demineralized bone matrix and hydroxyapatite complex previously applied were identified and removed.
OUTCOMES: Early initiation of both active and passive rehabilitation was implemented postoperatively without immobilization. At 4 years postoperatively, the patient demonstrated full active extension of the thumb IP joint, with no evidence of recurrence.
LESSONS: When using bone graft substitutes containing demineralized bone matrix or bone morphogenetic proteins, measures should be taken to prevent leakage into adjacent soft tissues, particularly in regions containing multiple tendons. In addition, any leaked bone graft substitute should be removed using techniques such as irrigation at the surgical site.