Abstract
Objective
Describe tendon injuries and their structural causes seen on ultrasound in wrists with distal radius fractures and estimate the accuracy of ultrasound and its impact on clinical management.
Materials and methods
Ultrasounds of 226 wrists (221 patients) with distal radius fractures were retrospectively reviewed. Ultrasound findings of tendon injuries and their structural causes were correlated with surgery and clinical outcome. Accuracy and inter- and intra-observer reproducibilities were calculated.
Results
Twenty-five wrists were treated non-operatively while 201 underwent surgery. Ultrasound demonstrated hardware contact with flexor pollicis longus (FPL) in 76 wrists, extensor pollicis longus (EPL) in 21, and other tendons in 94. Ultrasound identified tendon ruptures in 23 wrists (13 EPL/8 FPL/2 extensor indicis proprius (EIP)), most of which were surgically confirmed. Among 12 wrists with confirmed EPL ruptures, distal radius fracture had been treated with volar plating in 6 and non-operatively in 6, and ultrasound showed osseous irregularity at the rupture site in 8. All FPL ruptures occurred in wrists with volar plating. Ultrasound findings were concordant with subsequent clinical management in most. In 2, ultrasound findings led to the decision to remove hardware despite lack of symptoms. Ultrasound had sensitivity/specificity/accuracy of 88/99/98% for identifying a specific tendon as ruptured and 88/87/88% for tendon abnormalities in general. Inter- and intra-observer reproducibilities were excellent (kappa = 0.85 ~ 1.0).
Conclusion
Certain wrist tendons, particularly EPL and FPL, are vulnerable after distal radius fractures. Ultrasound is accurate and useful for detecting tendon injury and sources of tendon irritation and can guide clinical management.
Similar content being viewed by others
References
Larsen CF, Lauritsen J. Epidemiology of acute wrist trauma. Int J Epidemiol. 1993;22(5):911–6.
Asadollahi S, Keith PP. Flexor tendon injuries following plate fixation of distal radius fractures: a systematic review of the literature. J Orthop Traumatol. 2013;14(4):227–34.
Karantana A, Downing ND, Forward DP, et al. Surgical treatment of distal radial fractures with a volar locking plate versus conventional percutaneous methods: a randomized controlled trial. J Bone Joint Surg Am. 2013;95(19):1737–44.
Engkvist O, Lundborg G. Rupture of the extensor pollicis longus tendon after fracture of the lower end of the radius–a clinical and microangiographic study. Hand. 1979;11(1):76–86.
Helal B, Chen SC, Iwegbu G. Rupture of the extensor pollicis longus tendon in undisplaced Colles’ type of fracture. Hand. 1982;14(1):41–7.
Hirasawa Y, Katsumi Y, Akiyoshi T, Tamai K, Tokioka T. Clinical and microangiographic studies on rupture of the E.P.L. tendon after distal radial fractures. J Hand Surg Br. 1990;15(1):51–7.
Lourie GM, Putman A, Cates T, Peljovich AE. Extensor pollicis longus ruptures in distal radius fractures: clinical and cadaveric studies with a new therapeutic intervention. Am J Orthop (Belle Mead NJ). 2015;44(4):183–7.
Ghazal L, Nabi M, Little C, Teh J. Ultrasound assessment of extensor pollicis longus tendon rupture following distal radius fracture: a sonographic and surgical correlation. J Ultrason. 2020;20(80):e1–5.
Soong M, Earp BE, Bishop G, Leung A, Blazar P. Volar locking plate implant prominence and flexor tendon rupture. J Bone Joint Surg Am. 2011;93(4):328–35.
Kitay A, Swanstrom M, Schreiber JJ, et al. Volar plate position and flexor tendon rupture following distal radius fracture fixation. J Hand Surg Am. 2013;38(6):1091–6.
Owers KL, Lee J, Khan N, Healy J, Eckersley R. Ultrasound changes in the extensor pollicis longus tendon following fractures of the distal radius-a preliminary report. J Hand Surg Eur. 2007;32(4):467–71.
De Maeseneer M, Marcelis S, Osteaux M, Jager T, Machiels F, Roy PV. Sonography of a rupture of the tendon of the extensor pollicis longus muscle: initial clinical experience and correlation with findings at cadaveric dissection. AJR Am J Roentgenol. 2005;184(1):175–9.
Santiago FR, Plazas PG, Fernandez JMT. Sonography findings in tears of the extensor pollicis longus tendon and correlation with CT, MRI, and surgical findings. Eur J Radiol. 2008;66(1):112–6.
Bianchi S, van Aaken J, Glauser T, Martinoli C, Beaulieu JY, Della SD. Screw impingement on the extensor tendons in distal radius fractures treated by volar plating: sonographic appearance. AJR Am J Roentgenol. 2008;191(5):W199-203.
Sügün TS, Karabay N, Gürbüz Y, Özaksar K, Toros T, Kayalar M. Screw prominences related to palmar locking plating of distal radius. J Hand Surg Eur. 2011;36(4):320–4.
Kara A, Celik H, Bankaoglu M, Oc Y, Bulbul M, Sugun TS. Ultrasonic evaluation of the flexor pollicis longus tendon following volar plate fixation for distal radius fractures. J Hand Surg Am. 2016;41(3):374–80.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.
Soong M, van Leerdam R, Guitton TG, Got C, Katarincic J, Ring D. Fracture of the distal radius: risk factors for complications after locked volar plate fixation. J Hand Surg Am. 2011;36(1):3–9.
Casaletto JA, Machin D, Leung R, Brown DJ. Flexor pollicis longus tendon ruptures after palmar plate fixation of fractures of the distal radius. J Hand Surg Eur. 2009;34(4):471–4.
Drobetz H, Kutscha-Lissberg E. Osteosynthesis of distal radial fractures with a volar locking screw plate system. Int Orthop. 2003;27(1):1–6.
Sato K, Murakami K, Mimata Y, Doita M. Incidence of tendon rupture following volar plate fixation of distal radius fractures: a survey of 2787 cases. J Orthop. 2018;15(1):236–8.
Satake H, Hanaka N, Honma R, et al. Complications of distal radius fractures treated by volar locking plate fixation. Orthopedics. 2016;39(5):e893–6.
Roth KM, Blazar PE, Earp BE, Han R, Leung A. Incidence of extensor pollicis longus tendon rupture after nondisplaced distal radius fractures. J Hand Surg Am. 2012;37(5):942–7.
Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar lockingplate. J Orthop Trauma. 2007;21(5):316–22.
Tanaka Hiroyuki G, Koichi Y, Kosuke S, Yoshitaka H. Evaluation of flexor pollicis longus tendon attrition using color Doppler imaging after volar plate fixation for distal radius fracture. J Orthop Sci. 2017;22(3):447–52.
Bhat AK, Acharya AM, Mane PP, Karegowda LH. Correlation of flexor pollicis longus tendon status by ultrasonography with plate position on radiographs following volar plate fixation of distal radius fractures with pronator quadratus repair. Indian J Orthop. 2021;55(4):1015–21.
Bekhet CNH, Ghaffar MKA, Nassef MA, Khattab RT. Role of ultrasound in flexor tendon injuries of the hand: a new insight. Ultrasound Med Biol. 2021;47(8):2157–66.
Wu TS, Roque PJ, Green J, et al. Bedside ultrasound evaluation of tendon injuries. Am J Emerg Med. 2012;30(8):1617–21.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
Simon Sun, Christian Geannette, Natalie Braun, and Yoshimi Endo have nothing to declare.
Scott W Wolfe has the following disclosures, none of which are relevant to the current study:
Elsevier, Inc. – serves as Editor and receives royalties.
Extremity Medical, LLC – serves as a consultant, is an inventor for, and receives royalties.
TriMed, Inc – serves as a consultant and designer, on speaker’s bureau.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Sun, S., Geannette, C., Braun, N. et al. Diagnostic ultrasound of tendon injuries in the setting of distal radius fractures. Skeletal Radiol 51, 1463–1472 (2022). https://doi.org/10.1007/s00256-021-03985-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-021-03985-4