Delayed Rupture of Flexor Tendons due to a Malunion of Distal Radius Fracture

Tae Gyun Kim; Youn Moo Heo; Jin Woong Yi; Byung Hak Oh; Chang Uk Ham

doi:10.12790/ahm.2018.23.2.87

Journal List > Arch Hand Microsurg > v.23(2) > 1106636

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Kim, Heo, Yi, Oh, and Ham: Delayed Rupture of Flexor Tendons due to a Malunion of Distal Radius Fracture

Case Report

Arch Hand Microsurg 2018;23(2):87-92.

Published online: 5 January 2018

DOI: https://doi.org/10.12790/ahm.2018.23.2.87

Delayed Rupture of Flexor Tendons due to a Malunion of Distal Radius Fracture

Tae Gyun Kim, Youn Moo Heo, Jin Woong Yi, Byung Hak Oh, Chang Uk Ham

Department of Orthopedic Surgery, College of Medicine, Konyang University, Daejeon, Korea

Corresponding author: Youn Moo Heo Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35391, Korea TEL: +82-42-600-6902, FAX: +82-42-545-2373, E-mail: hurym1973@hanmail.net

Received 2 February 201831 March 2018 Accepted 6 April 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Tendon ruptures of the finger may occur due to various causes around the wrist. Because the malunion of distal radius af-fects the morphology of distal radioulnar joint (DRUJ), it may cause an arthritis of this joint. Progression of arthritis of the DRUJ may result in bony spurs, dislocation of ulnar head, or change of inclination of sigmoid notch. These changes can cause the attritional rupture of tendons around the DRUJ. We experienced an attritional rupture of 4/5th flexor tendons in a patient with arthritis of the DRUJ and palmar subluxation of ulnar head caused by malunion of distal radius. Although an attritional rupture of flexor tendons is less common than that of extensor tendons, progression of attritional ruptures and management are similar. However, because there are some differences between the former and the latter in radiologic findings and surgical considerations, we report this case with a review of the literature.

Keywords: Distal radius, Distal radioulnar joint, Malunion, Arthritis, Flexor tendon rupture

REFERENCES

1.Turner RG., Faber KJ., Athwal GS. Complications of distal radius fractures. Hand Clin. 2010. 26:85–96.

2.Davis DI., Baratz M. Soft tissue complications of distal radius fractures. Hand Clin. 2010. 26:229–35.

3.Heo YM., Kim SB., Kim KK., Kim DH., Park WK. Acute rupture of flexor tendons as a complication of distal radius fracture. J Korean Orthop Assoc. 2015. 50:60–5.

4.Valbuena SE., Cogswell LK., Baraziol R., Valenti P. Rupture of flexor tendon following volar plate of distal radius fracture. Report of five cases. Chir Main. 2010. 29:109–13.

5.Murase T., Hiroshima K. Rupture of the flexor tendon after malunited Colles’ fracture. Scand J Plast Reconstr Surg Hand Surg. 2003. 37:188–91.

6.Lamas C., Proubasta I., Itarte J., Peiró A., Majó J. Rupture of all the flexor tendons in the hand due to malunion of a distal radius fracture. Chir Main. 2004. 23:45–8.

7.Huh SW., Jo WL., Lee JY. Rupture of flexor tendons as a complication of a distal radius fracture. J Plast Surg Hand Surg. 2014. 48:350–2.

8.Ishii T., Ikeda M., Kobayashi Y., Mochida J., Oka Y. Flexor digitorum profundus tendon rupture associated with distal radius fracture malunion: a case report. Hand Surg. 2009. 14:35–8.

9.Nagy MT., Ghosh S., Shah B., Sankar T. Delayed rupture of flexor tendons in zone V complicated by neuritis 18 years following Galeazzi fracture-dislocation. BMJ Case Rep. 2014. 2014:bcr2013010188.

10.Yamazaki H., Uchiyama S., Hata Y., Murakami N., Kato H. Extensor tendon rupture associated with osteoarthri-tis of the distal radioulnar joint. J Hand Surg Eur Vol. 2008. 33:469–74.

Fig.1.

Clinical photographs showing volar swelling of left wrist (A) and limitation of active flexion of the left fourth and fifth fingers (B).

Fig.2.

(A, B) Plain radiographs showed malunion of the distal radius associated with arthritis of distal radioulnar joint and palmar subluxation of ulnar head. And deepening and widening of the sigmoid notch was confirmed on postero-anterior view, that reported as the ‘scallop sign’. (C, D) Magnetic resonance imaging showed attritional tenosynovitis of flexor tendons due to the palmar bony spur of ulnar head on sagittal image and increased palmar inclination of the sigmoid notch on axial image.

Fig.3.

Intraoperative photograph showing severe compression of median nerve, rupture of flexor digitorum profundus tendon of 4th finger and flexor digitorum profundus/superficialis tendon of 5th finger, and rupture of distal radioulnar joint capsule after flexor teno-synovetomy and carpal tunnel release.

Fig.4.

Radiographs at 6 months follow-up.

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