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Ultrasound assessment of extensor pollicis longus tendon rupture following distal radius fracture: a sonographic and surgical correlation

Louy Ghazal
Louy Ghazal
, 
Mohammed Nabi
Mohammed Nabi
, 
Christopher Little
Christopher Little
 and 
James Teh
James Teh
   | Mar 31, 2020
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Article Category: research-article
Published Online: Mar 31, 2020
Page range: 1 - 5
Received: Oct 15, 2019
Accepted: Nov 10, 2019
DOI: https://doi.org/10.15557/jou.2020.0001
Keywords
© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

Panoramic longitudinal sonogram at the level of the distal radius demonstrating effusion within compartment III sheath (arrow)
Panoramic longitudinal sonogram at the level of the distal radius demonstrating effusion within compartment III sheath (arrow)

Fig. 2.

Longitudinal image showing empty tendon sheath of the EPL depicted between cross markers, with the extensor carpi radialis longus seen deep to the EPL tendon sheath
Longitudinal image showing empty tendon sheath of the EPL depicted between cross markers, with the extensor carpi radialis longus seen deep to the EPL tendon sheath

Fig. 3.

Sonogram in the longitudinal plane illustrating neovascularity of the EPL tendon sheath on Doppler mode US
Sonogram in the longitudinal plane illustrating neovascularity of the EPL tendon sheath on Doppler mode US

Fig. 4.

Sonogram illustrating thickened hypoechoic appearance of the proximal retracted EPL stump in the transverse plane ( A ), and panoramic longitudinal view ( B ) illustrating that both the EPL tendon ends are retracted (cross markers), hypoechoic and enlarged
Sonogram illustrating thickened hypoechoic appearance of the proximal retracted EPL stump in the transverse plane ( A ), and panoramic longitudinal view ( B ) illustrating that both the EPL tendon ends are retracted (cross markers), hypoechoic and enlarged

Fig. 5.

A. Transverse ultrasound image illustrates a fracture extending through Lister’s tubercle, resulting in an irregular dorsal cortex (arrow) and the EPL tendon in cross-section (arrow head) close to the fracture edge. B. Longitudinal sonogram demonstrates fracture of Lister’s tubercle at the site of the EPL tendon rupture. C. Fracture extending through Lister’s tubercle, resulting in dorsal cortex irregularity (arrow) and effusion within the EPL sheath (arrow head)
A. Transverse ultrasound image illustrates a fracture extending through Lister’s tubercle, resulting in an irregular dorsal cortex (arrow) and the EPL tendon in cross-section (arrow head) close to the fracture edge. B. Longitudinal sonogram demonstrates fracture of Lister’s tubercle at the site of the EPL tendon rupture. C. Fracture extending through Lister’s tubercle, resulting in dorsal cortex irregularity (arrow) and effusion within the EPL sheath (arrow head)

Fig. 6.

Sonogram of the distal radius in the transverse plane illustrating the radial (r) and ulnar (u) peaks of Lister’s tubercle of similar heights
Sonogram of the distal radius in the transverse plane illustrating the radial (r) and ulnar (u) peaks of Lister’s tubercle of similar heights

Proportion of fractures involving Lister’s tubercle identified on radiography and US

Injury type No of cases identified on radiography Fracture extends into Lister’s tubercle on radiography Fracture extends into Lister’s tubercle onUS
Undisplaced/minimally displaced distal radius fracture 6 3 6
Displaced distal radius fracture 2 1 2
Non-fracture injury 3 – 1

Summary of US findings

EPL Sonographic findings Cases
Level of rupture
Proximal (Lister's tubercle) 11
Distal (Distal phalanx) 0
Tendon end retraction
Gap range (cm) 1.4-3.6
Gap average (cm) 2.4
Tendon end state
Enlarged and hypoechoic 9
Atrophicends 0
Unremarkable appearances 2
Tendon sheath
Effusion 3rd compartment 10
Effusion 2nd compartment 9
Empty tendon sheath 1
Tenosynovitis 2
Lister’s tubercle
Fracture resulting in irregularity 9
Variant anatomy 1
Smooth cortex 1

Summary of patient characteristics, time interval of US and surgical procedure

Patient No. Age Gender Time to US after injury (wks) Operative technique
1 23 F 14 EIP to EPL transfer
2 25 M 4 EPL repair PL graft
3 54 M 2 EIP to EPL transfer
4 47 M 4 No operation
5 61 F 4 No operation
6 35 F 2 EIP to EPL transfer
7 71 F 3 EIP to EPL transfer
8 70 F <1 EIP to EPL transfer
9 63 F 4 No operation
10 48 F 4 EPL repair PL graft
11 65 f 8 EIP to EPL transfer
eISSN:
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Language:
English
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Journal Subjects:
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