Pal Jitendra Nath, Bera Amiya Kumar, Roy Amarendra Nath, Bari Wasim
Department of Orthopedics, Murshidabad Medical College, PO - Berhampore, District - Murshidabad, West Bengal Pin-742101, India.
J Orthop Case Rep. 2016 Jul-Aug;6(3):25-27. doi: 10.13107/jocr.2250-0685.486.
Spontaneous ruptures of extension pollicis longus tendon predominantly occur after undisplaced or minimally displaced distal radial fracture near Lister tubercle. Systemic inflammatory diseases and systemic or local steroid, mechanical causes like bony ridges, presence of bone plate or external fixator pin may precipitate this. Repetitive uses in certain occupation like cooking, cow milking, tailoring and direct trauma in kick boxer are also identified as cause. In this study it is caused by screw tip that also after 20 years. Instead of tendon transfer, interposition tendon grafting is preferred.
A 36-year-old male manual worker was plated for distal radial shaft fracture of left side. Distal most screw length was 3 mm in excess. After 20 years he developed rupture of extensor pollicislongus spontaneously. After excluding probable other causes and confirming by USG tendon ends were explored through dorsal incision. Offending slotted head screw was removed using hollow mill. Ipsilateral Palmaris longus tendon was grafted. Tension was set by extension of thumb and neutral position of the wrist. Removal of stitch after 2 weeks, short arm cast immobilization for 6 week and intermittent splinting and exercises for another 6 weeks yield excellent result.
Timely removal of implant when it is applied over tendon rich areas is preferable. In late situation surgeon should be equipped and careful to remove it. To avoid chance of transferring a diseased tendon interposition grafting using Palmaris longus is justified.
拇长伸肌腱自发性断裂主要发生在靠近Lister结节的无移位或轻度移位的桡骨远端骨折后。全身性炎症疾病、全身性或局部使用类固醇、诸如骨嵴、骨板或外固定针等机械性原因可能促使其发生。某些职业（如烹饪、挤牛奶、裁缝）的重复性动作以及搏击运动员遭受的直接创伤也被确定为病因。在本研究中，病因是螺钉尖端，且也是在20年后才出现问题。相较于肌腱转移，更倾向于采用间置肌腱移植术。
一名36岁男性体力劳动者因左侧桡骨干远端骨折接受钢板固定。最远端的螺钉长了3毫米。20年后，他拇长伸肌自发断裂。在排除其他可能病因并经超声检查确认后，通过背侧切口探查肌腱断端。使用空心铣刀取出有问题的开槽头螺钉。移植同侧掌长肌腱。通过拇指伸展和手腕中立位来设定张力。2周后拆线，短臂石膏固定6周，之后再进行6周的间歇性夹板固定和锻炼，效果极佳。
当植入物应用于肌腱丰富区域时，最好及时取出。在后期情况中，外科医生应具备相应能力并小心地取出它。为避免转移病变肌腱的可能性，使用掌长肌进行间置移植是合理的。
