Uemura Takuya, Okano Tadashi, Onode Ema, Yokoi Takuya, Shintani Kosuke, Okada Mitsuhiro, Nakamura Hiroaki
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
J Med Ultrason (2001). 2018 Oct;45(4):647-651. doi: 10.1007/s10396-018-0882-1. Epub 2018 Apr 27.
Flexor pollicis longus (FPL) tendon rupture is a major complication of volar locking plate fixation for distal radius fractures. The tendon rupture is usually caused by friction between the distal edge of the plate and the FPL tendon, and has been well detected recently with ultrasonography. Rarely, the volar locking plate itself entraps the FPL tendon, leading to its rupture. A 63-year-old man was consistently unable to flex his right thumb after previous surgery for a distal radius fracture at another hospital. Ultrasonography demonstrated loss of tendon gliding and unusual patterns of the FPL tendon. The tendon was sandwiched between the plate and the distal radius, and was penetrated by the distal locking screw, which was comparable to intraoperative findings of complete entrapment and rupture of the FPL tendon from the underlying plate. The tendon defects were repaired using a palmaris longus tendon graft after removing the screws and plate. Finally, he could flex his thumb actively with satisfaction. Unusual patterns of FPL tendon rupture buried under inadequate plate positioning must be recognized, as in this case. Ultrasonographic assessment is routinely recommended to visibly determine any FPL tendon damage after volar locking plate fixation for distal radius fractures.
拇长屈肌腱（FPL）断裂是桡骨远端骨折掌侧锁定钢板固定的一种主要并发症。肌腱断裂通常由钢板远端边缘与FPL肌腱之间的摩擦引起，最近通过超声检查已能很好地检测到。很少见的情况是，掌侧锁定钢板本身会卡压FPL肌腱，导致其断裂。一名63岁男性在另一家医院接受桡骨远端骨折手术后，右手拇指持续无法屈曲。超声检查显示肌腱滑动丧失以及FPL肌腱出现异常形态。肌腱被夹在钢板与桡骨远端之间，并被远端锁定螺钉穿透，这与术中发现的FPL肌腱从下方钢板完全卡压和断裂的情况相符。在移除螺钉和钢板后，使用掌长肌腱移植修复肌腱缺损。最后，他的拇指能够主动屈曲，效果满意。必须认识到像本例中因钢板位置不当而隐匿的FPL肌腱断裂的异常形态。对于桡骨远端骨折掌侧锁定钢板固定术后，常规建议进行超声评估以明确判断FPL肌腱是否受损。
