Nigh Evan D, Emerson Christopher P, To David, Barnhill Spencer, Rizzo Michael G, Nguyen Duc M, Ugarte Ane, Muñera Felipe, Greif Dylan N, Jose Jean, Dodds Seth D
Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida.
J Wrist Surg. 2020 Apr;9(2):129-135. doi: 10.1055/s-0039-3402424. Epub 2019 Dec 24.
To examine the association between distal radius fractures and tendon entrapment identified on computed tomography (CT) imaging. After Institutional Review Board approval, we retrospectively reviewed distal radius fractures that underwent CT imaging from an electronic database between January 2006 to February 2018 at a single level 1 hospital trauma center. We categorized all distal radial fractures according to the AO-OTA (AO Foundation/Orthopaedic Trauma Association) classification. Distal upper extremity tendons were assessed for entrapment. Fisher's exact test was used for statistical analysis with significance at < 0.05. A total of 183 distal radius fractures were identified in 179 patients. A total of 16 fractures (13 males and 3 females) were associated with tendon entrapment. Mechanism of injury included falls ( = 7), motor vehicle accidents ( = 6), dog bites ( = 2), and gunshot wound ( = 1). Entrapped tendons were limited to the extensor compartment and included the extensor pollicis longus (EPL; = 11), extensor pollicis brevis ( = 1), extensor carpi ulnaris ( = 1), extensor carpi radialis longus ( = 1), and extensor digitorum communis ( = 2). The most commonly associated AO-OTA fracture pattern with tendon entrapment was complete articular radial fractures (2R3C; 69%), eight of which were simple articular with metaphyseal multifragmentary fractures (2R3C2). Of the distal radius fractures, 81% were associated with additional ulnar fractures of varying severity and displacement. Approximately 8.7% of distal radius fractures were retrospectively identified to have tendon entrapment compared with a previously reported incidence of 1.3%. Wrist surgeons and radiologists should have higher suspicion for tendon entrapment and carefully review preoperative CT imaging for tendon entrapment in distal radius fractures especially if there is an intra-articular, multifragmentary injury pattern. Wrist surgeons and radiologists should also have increased suspicion for EPL tendon entrapments given its high incidence in association with distal radius fractures. This is a Level III, retrospective cross-sectional study.
探讨计算机断层扫描（CT）影像显示的桡骨远端骨折与肌腱卡压之间的关联。
在获得机构审查委员会批准后，我们回顾性分析了2006年1月至2018年2月间在一家一级医院创伤中心的电子数据库中接受CT检查的桡骨远端骨折病例。我们根据AO-OTA（AO基金会/骨科创伤协会）分类法对所有桡骨远端骨折进行分类。评估上肢远端肌腱是否存在卡压情况。采用Fisher精确检验进行统计学分析，显著性水平设定为<0.05。
共识别出179例患者的183处桡骨远端骨折。其中共有16处骨折（13例男性，3例女性）合并肌腱卡压。致伤机制包括跌倒（n = 7）、机动车事故（n = 6）、犬咬伤（n = 2）和枪伤（n = 1）。卡压的肌腱仅限于伸肌间隙，包括拇长伸肌（EPL；n = 11）、拇短伸肌（n = 1）、尺侧腕伸肌（n = 1）、桡侧腕长伸肌（n = 1）和指总伸肌（n = 2）。与肌腱卡压最常相关的AO-OTA骨折类型为完全关节面桡骨骨折（2R3C；69%），其中8例为单纯关节面骨折合并干骺端多段骨折（2R3C2）。在桡骨远端骨折中，81%合并不同严重程度和移位的尺骨骨折。
回顾性分析发现，约8.7%的桡骨远端骨折合并肌腱卡压，而此前报道的发生率为1.3%。腕关节外科医生和放射科医生应提高对肌腱卡压的怀疑，并仔细复查桡骨远端骨折术前CT影像以排查肌腱卡压情况，尤其是存在关节内、多段损伤模式时。鉴于拇长伸肌腱卡压与桡骨远端骨折的高相关性，腕关节外科医生和放射科医生也应提高对其的怀疑。
这是一项III级回顾性横断面研究。
