Saito Taichi, Furutani Tomoki, Nakamichi Ryo, Nakahara Ryuichi, Kondo Hidenori, Shimamura Yasunori, Imatani Junya, Ozaki Toshifumi
Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Injury. 2025 Aug;56(8):112454. doi: 10.1016/j.injury.2025.112454. Epub 2025 May 24.
Distal radius fractures (DRFs) are common, with an increasing incidence, particularly among the elderly. Rupture of the extensor pollicis longus (EPL) tendon, essential for thumb extension, is a notable complication, especially in non-displaced DRFs. Several mechanisms, such as local adhesion, ischemic atrophy, and tendon laceration, are associated with EPL tendon rupture. This multicenter retrospective study aims to identify risk factors for EPL tendon rupture in non-displaced DRFs.
The study reviewed 20 cases of EPL tendon rupture and 52 control cases from 2005 to 2022, excluding those who underwent surgery or had incomplete computed tomography (CT) data. We investigated age, sex, location of fracture line, and the morphology of Lister's tubercle as variables. Logistic regression and decision tree analyses were employed to determine the risk factors for EPL tendon rupture based on these variables.
Fracture lines distal to Lister's tubercle and specific shapes of Lister's tubercle, characterized by shallow peak height and a higher radial peak than the ulnar peak, increased the risk of EPL tendon rupture. Decision tree analysis confirmed them as major risk factors. There was a significant difference in the predicted probability rate of tendon rupture between the case with these factors and those without them (P < 0.001). Conversely, the location and size of Lister's tubercle did not affect the incidence of EPL tendon rupture.
The location of fracture line and the shape of Lister's tubercle are key factors influencing EPL tendon rupture in non-displaced DRFs. Understanding these factors can help orthopedic surgeons predict and prevent EPL tendon ruptures, improving patient outcomes following these fractures.
桡骨远端骨折（DRF）很常见，且发病率呈上升趋势，在老年人中尤为如此。拇长伸肌（EPL）肌腱断裂是拇指伸展所必需的，是一种值得注意的并发症，尤其是在无移位的DRF中。局部粘连、缺血性萎缩和肌腱撕裂等多种机制与EPL肌腱断裂有关。这项多中心回顾性研究旨在确定无移位DRF中EPL肌腱断裂的危险因素。
该研究回顾了2005年至2022年期间20例EPL肌腱断裂病例和52例对照病例，排除了接受过手术或计算机断层扫描（CT）数据不完整的患者。我们将年龄、性别、骨折线位置和Lister结节形态作为变量进行研究。采用逻辑回归和决策树分析，根据这些变量确定EPL肌腱断裂的危险因素。
Lister结节远端的骨折线以及Lister结节的特定形状，其特征为峰值高度浅且桡侧峰值高于尺侧峰值，增加了EPL肌腱断裂的风险。决策树分析证实它们是主要危险因素。有这些因素的病例与没有这些因素的病例相比，肌腱断裂的预测概率率存在显著差异（P < 0.001）。相反，Lister结节的位置和大小并未影响EPL肌腱断裂的发生率。
骨折线位置和Lister结节形状是影响无移位DRF中EPL肌腱断裂的关键因素。了解这些因素有助于骨科医生预测和预防EPL肌腱断裂，改善这些骨折患者的预后。
