BRIEF
ENTRAPMENT
OF
EXTENSOR
TENDONS
BRIEF
W.
Although
entrapment
of
the
GARETH
extensor
pollicis
THOMAS,
longus
incision,
soft
with
2). She was
was assumed
an associated
fracture
her
of
of the ulna
1 and
unable
to extend
her fingers
actively
but
that this was due to pain from the fracture.
it
and
fixed
operating
A dorsal
and the
interosseus
bicycle
the left
(Figs
FRACFURE:
with
K-wires.
theatre
again
incision
was
tissue
interposition.
The extensor
retinaculum
aspect
girl fell from
Smith’s
fracture
reduced
in the
reduction.
We describe
such
a case,
the entraprecognised
at operation.
Pre-operative
have
eased
the
surgical
procedure
Case
report.
A 1 3-year-old
suffering
a Salter
type
II
A SMITH’S
C. J. KERSHAW
taken
considerably.
radius
IN
REPORT
tendon
in association
with a Smith’s
fracture
has been
reported
previously,
a search
of the literature
has failed
to reveal
a case in which
all the extensor
tendons
have
been
entrapped.
ment
only being
diagnosis
would
491
REPORTS
A radiograph
showed
then
was
failure
made
found
of
to exclude
to be disrupted
extensor
tendons
had passed
through
the torn
membrane
from
the dorsal
to the ventral
of
tendons
cortical
the
wrist
at
the
level
were
freed
and
the
screws.
The
patient
uncomplicated
Discussion.
In
recovery.
two
of
of
the
fracture.
fracture
fixed
subsequently
the
three
The
with
made
reported
two
an
cases
of
entrapment
of the extensor
pollicis
longus
tendon
in
association
with
a fracture
of the distal
radius
the
diagnosis
was only made
some
weeks
after
the injury
when
the patients
returned
with inability
to extend
the
flexed
thumb
(Hunt
1969; Murakami
and Todani
1981;
Morrissey
and Nalebuff
1977). There
was similar
delay
in our
case.
It is believed
forced
that
over-pronation
a Smith’s
(Evans
fracture
results
The
mechanism
1951).
from
of
entrapment
of the extensor
pollicis
longus
tendon
was
described
by Hunt
(1969),
who postulated
that
at the
instant
of fracture
the
proximal
fragment
emerges
between
extensor
pollicis
brevis
and extensor
pollicis
longus.
Subsequent
supination
of the proximal
fragment
Fig.
A
closed
1
Fig.
manipulation
radiographs
showed
been
achieved.
the fracture
was
that
A further
was therefore
also
through
W. G. Thomas,
BSc, FRCS,
Senior
Orthopaedic
C. J. Kershaw,
FRCS,
Orthopaedic
Registrar
Orthopaedic
Department,
Southampton
General
Road,
Shirley,
Southampton,
England.
Correspondence
to
Mr
W.
©
G.
70-B,
No.
3, MAY
1988
of Bone
check
had
might
cause
entrapment
of not
only
the
extensor
pollicis
not
but also the extensor
digitorum
tendons.
Inability
to extend
the thumb
or fingers
following
Smith’s
fracture
should
alert the surgeon
to the possibility of tendon
entrapment
and exploration
of the fracture
through
a dorsal
approach
may be necessary.
failed
and
a ventral
Registrar
Hospital,
Tremona
REFERENCES
Evans
EM. Fractures
of the
1951 ,33-B:548-61.
Hunt
DD. Dislocation
of the extensor
fracture
of the radius
: a case
1969:51-A
:991-4.
radius
and
ulna.
pollicis
report.
J Bone
Joint
longus
tendon
J Bone
Joint
Surg
and
Joint
Surgery
Y, Todani
K. Traumatic
entrapment
of the extensor
longus
tendon
in Smith’s
fracture
of the radius
: case report.
Surg 1981 :6:238-40.
Morrissey
RI,
entrapment:
Nalebuff
a case
EA.
report.
Distal
radial
fracture
C/in Orthop
1977:124:205-8.
[Br]
in Smith’s
Surg [Am]
Murakami
Thomas.
1988 British
Editorial
Society
030l-620X/88/R55
$2.00
J Bone Joint Surg [Br] 1988,70-B:491.
VOL.
but
reduction
manipulation
exposed
the tendon
towards
the ulna and dislocation
of the
into the fracture
results
in its entrapment.
It is
that a similar
but more violent
sequence
of events
longus
2
performed
a satisfactory
carries
tendon
likely
with
pollicis
J Hand
tendon
a