Volar plate fixation hnua extensor tendon rupture hi distal radius fracture siamthatna kawngah harsatna lian tak a la ni reng a ni. Tendon a nghawng tam ber chu extensor pollicis longus (EPL) tendon a ni a, EPL groove chhungah a inkhung tlat avangin. Volar plating hnua EPL tendon rupture awm zat report chu 0.29%–5.7% a ni.
EPL tendon rupture tlai lutuk hi dorsal screw protrusion, intraoperative direct drilling atanga hliam, leh dorsal roof fragment awmnaah a sang a, a bik takin Lister’s tubercle island fracture-ah te hian a sang hle. Distal radius fracture-a screw protrusion radiographic assessment hi distal radius-a geometry complex tak leh comminuted dorsal fracture awm theihna avang hian a harsa hle. Dorsal tangential view hi dorsal radial cortex intravital view awm thei awmchhun a ni a, screw tip leh dorsal cortex inkar hlat zawng tehna rintlak tak a ni.
Extensor tendon hliam laka invenna technique hrang hrangte chu monocortical screw hman leh dorsal surface penetration pumpelh te; mahse, heng technique te hian fracture repair-a mechanical stability a tihziaawm thei a ni. Chuvangin bicortical fixation pawh a ngai fo thin. Extensor tendon hliam hlauhawmna tihtlem nan chuan fracture fixation leh stability tum ber chu tihchhiat a ngai lo.
Surgery hman dan thar
Distal radius fractures volar plate fixation hnua EPL tendon rupture hlauhawmna tih tlem nan screw sei zawng tih tawi emaw, dorsal roof fragment te paih emaw loh nan novel technique kan sawi a. A tawi zawngin, he technique hian dorsal incision te tak te hmangin compartment pathumna chu hawn a ni.
Screw chu dorsal cortex chhungah a lut a, compartment pathumnaah a rawn chhuak a nih chuan: EPL tendon chu a groove atangin kan la chhuak a, retinaculum chu suture hmangin kan khar a, EPL tendon chu retinaculum siamthat tawhah kan chhuahsan a ni.
Screw chu compartment pathumnaah a inzar pharh loh chuan: EPL tendon chu compartment pathumnaah kan dah a. Kan technique atana indication chu distal radius fracture nei, volar locking plate hmanga enkawl, dorso-parietal fragment emaw screw emaw hmanga fracture, dorsal cortex chhunga lut thei emaw, Lister’s tubercle vel EPL tendon tichhe thei emaw damlote tan a ni. Distal radius fracture nei, dorsomedial fragment nei damloteah chuan dorsal cortex chhunga lut turin hole kan drill a, dorsomedial fragment nghet lo tak takte siamthat theihna tur screw sei tawk kan thlang thin.
Case insem darh a ni
Kan share a, dorsomedial fragments hmanga comminuted distal radius fracture plate fixation neih laiin compartment pathumnaah screw a lo chhuah avangin EPL tendon chu compartment pathumna atanga lakchhuah a ni. EPL tendon chu operation hnu kum 7 chhungin a la awm reng tih kan nemnghet a, mahse compartment pathumnaah chuan screw chu a langsar hle.
He case hi hmeichhe kum 67 mi niin, intra-articular unstable distal radius fracture a nei a, right dorsal medial fracture a nei tih hmuhchhuah a ni bawk (Figure 1A-E). Meizial zu, zunthlum leh zu in tawhna history a awm lo. Kea kaltu awm lovin a kal thei.
![distal radius a awm a ni]()
figure 1. Preoperative imaging-ah chuan distal radius-a intra-articular fracture comminuted a awm tih hmuhchhuah a ni.
A leh B: Operation hmaa X-ray, .
C leh D: computed tomography thlalak sagittal leh axial view, .
E: 3D computed tomography hmanga thlalak a ni. Dorsal medial lunate facet fragment leh dorsal apical fragment (asterisk dum) te chu hmuh theih a ni.
Surgery hman dan tur
He fracture system hi volar locking plate hmangin kan enkawl a. Intraoperative-ah dorsal cortex kan drill a, dorsomedial fragment a nghet loh avangin dorsal cortex secure turin screw sei tawk kan thlang a (Figure 2).
Screw fixation hnuah compartment pathumna hawn nan operation an nei a.
Screw hian compartment pathumna a luhchilh a, a rawn chhuak tawh avangin (Figure 3A), compartment pathumna chu hawng kim vek la, EPL tendon chu a groove atang chuan chhuah tir rawh (Figure 3B).
Chumi hnuah chuan compartment pathumna chu retinaculum suture hmangin an khar a (Fig. 3C,D), EPL tendon chu retinaculum siamthat tawh chungah an dah a (Fig. 3 E).
Surgery zawhah damlo chu kan damdawi ina outpatient clinic-ah a ruh a dam hma loh chuan a kal a. Damlo chuan hardware chu a paih duh lo.
Operation hnua dam lehna
Operation an neih atanga kum sarih hnuah damlo hi ruh natna avangin damdawi inah enfiah leh turin a kir leh a ni. Kut dinglam hi rualbanlo a ni lo. X-ray image-ah chuan distal locking screw dorsal protrusion awmna fracture dam tawh a ni. Damlo kutpui chu a sei kim vek a, EPL tendon-ah pawh bowstring langsar tak a awm lo.
Kan rawtna angin damlo chuan hardware chu la chhuakin extensor tendons te chu enfiah turin a remti ta a ni. Intraoperative-ah EPL tendon chu dorsal incision hmangin kan enfiah a, compartment pathumna leh palina chu a then kan hawng a.
EPL tendon hi third compartment pawnah operation hmasa ang bawkin a awm a, tendon chu a thinrim lo.
Screw chu third compartment-ah a lut tih kan nemnghet a, chu chu kut zungtang extensor tendons te chu an hnukkir leh a ni.
A tawpah chuan support strap te chu kan siam tha a, hardware te chu kan la chhuak ta a. Hardware lakchhuah atanga thla 2 hnuah final evaluation-ah chuan damlo chu pain free a ni a, full thumb extension a nei bawk.
Sawiho
Kan approach-ah chuan distal radius fractures volar plate fixation hnuah, Lister tubercle thlenga ulnar cm 2 vel sei incision hmangin compartment pathumna chu a then kan hawng a. EPL tendon leh third extensor compartment floor chu EPL tendon chu zawi zawiin kan hnukkir lehin direct-in kan hre thei a.
Screw hian dorsal cortex chu third compartment-ah a luhchilh emaw, dorso-parietal debris a neih emaw chuan intraoperative screw replacement emaw fragmentectomy emaw kan ti lo va, compartment pathumna chu kan hawng vek a, EPL tendon chu a groove atangin kan la chhuak a ni. Chumi hnuah chuan compartment pathumnaah EPL tendon chu repositioning laiin retinaculum suture hmangin compartment chu kan khar ta a ni.
Screw chu third compartment-ah a inzar pharh lo a nih chuan EPL tendon chu a then hawn third compartment-ah kan dah ta a ni.
Kan surgical technique hmang hian EPL tendon hliam te chu direct visualization hmangin minute 10 dang pawh awlsam taka enfiah theih a ni. EPL tendon a inhliam chuan direct-a siamthat theih a ni. Hetiang tih hian distal radial plate fixation hnua secondary EPL tendon rupture a awm loh nan a pui a ni. EPL tendon bowstring a awm thei a, mahse kan dinhmunah chuan a thleng lo.
Thutawp atan chuan
Kan tawng a, EPL tendon chu operation hnu kum 7 chhungin a awm reng a, mahse volar plate siam thatna atana hman screw te chu compartment pathumnaah a langsar hle. Kan surgical technique hian distal radius fracture avanga volar plate fixation hnua EPL tendon rupture awm theihna a ti tlem hle.
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