|Beitragstitel||Extensor pollicis longus (EPL) tendon laceration after elastic stable intramedullary nailing (ESIN) of shaft fractures of radius in children with nail insertion at Lister’s tubercule: we report four cases.|
ESIN is an established method for treatment of unstable forearm shaft fractures in children. Two entry points for retrograde intramedullary nailing of the radius are described: proximal to the growth plate in line with the styloid process or to second at the Lister’s tubercule. The latter is commonly chosen for metaphyseal distal fractures. A lesion of the EPL tendon as a complication after ESIN is reported at a rate of 1.5% to 1.9%. As the tendon passes ulnary to the Lister’s tubercule it is prone for lesion as it has direct contact with the ESIN.
We report 4 cases operated from February 2019 to October 2019 of children aged 11 years and 1 month and 14 years and 3 month (mean 12.8 years) who underwent reduction and stabilization of forearm fractures with ESIN where the entry point of the nail was chosen at the Lister’s tubercule, who subsequently developed an EPL lesion in zone 7. The lesions were diagnosed before hardware removal and in one case intraoperatively during hardware removal thus 12 to 32 weeks after osteosynthesis on average 22.8 weeks. In three patients a 100% tendon rupture was present and in one case a 90% lesion. We suppose the lesions to be caused by friction, as the nails were introduced by an open approach. One EPL was reconstructed by extensor indicis-transfer and one with a palmaris longus transplant. The incomplete EPL lesion was sutured and reinforced with an extensor carpi radialis brevis graft. The forth patient demonstrated some active retropulsion and extension at the interphalangeal joint. An ultrasonography showed adhesions between the ruptured EPL and the intact extensor pollicis brevis. This explains the remaining function of the thumb. As the patient was not bothered he denied revision together with his parents. During the same period, a total of 24 children underwent operative stabilization with ESIN of the radius.
Over a period of 10 months there was a significant number of EPL tendon lesions in our department of 16,7% as the entry point for the ESIN was chosen at the Lister’s tubercule.
The entry point ulnar to the Lister’s tubercule for ESIN for osteosynthesis in diaphyseal radius fractures in children must be avoided in order to prevent laceration of the EPL tendon.