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Diagnostic ultrasound of tendon injuries in the setting of distal radius fractures

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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.

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Authors and Affiliations

  1. Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA

    Simon Sun, Christian Geannette & Yoshimi Endo

  2. Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY, USA

    Natalie Braun & Scott W. Wolfe

Authors
  1. Simon Sun
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  2. Christian Geannette
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  3. Natalie Braun
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  4. Scott W. Wolfe
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  5. Yoshimi Endo
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Corresponding author

Correspondence to Yoshimi Endo.

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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.

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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

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  • DOI: https://doi.org/10.1007/s00256-021-03985-4

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