Entrapment of the Extensor Indicis Proprius Tendon after Open Reduction and Internal Fixation of Distal Ulna: Case Report and Discussion of the Diagnosis and Surgical Result

Shao-Min Shi; Steven I. Grindel; Glenn G. Shi; Patrick J. Reardon; Dara J. Mickschl

doi:10.1055/s-0038-1672337

Journal of Hand and Microsurgery, Table of Contents

J Hand Microsurg 2019; 11(03): 166-169
DOI: 10.1055/s-0038-1672337

Case Report

Society of Indian Hand & Microsurgeons

Entrapment of the Extensor Indicis Proprius Tendon after Open Reduction and Internal Fixation of Distal Ulna: Case Report and Discussion of the Diagnosis and Surgical Result

Shao-Min Shi

¹Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States

,

Steven I. Grindel

¹Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States

,

Glenn G. Shi

²Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, Florida, United States

,

Patrick J. Reardon

¹Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States

,

Dara J. Mickschl

¹Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States

› Author Affiliations

Abstract

Entrapment of the extensor indicis proprius (EIP) after open reduction and internal fixation (ORIF) of the distal ulna with a plate and screw construct is rare. By literature review, we found evidence of such complication associated with distal radius fracture, but no past reports relating to the distal ulna. ORIF of the distal ulna is a common procedure for both fracture treatment and deformity correction. Due to the EIP muscle originating primarily from the dorsoradial surface of the distal ulna and the adjacent interosseous membrane, the muscle may be damaged or compressed by a fixation plate during ORIF, resulting in entrapment. We present two case reports of this rare complication, describing the method of clinical diagnosis, surgical treatment, and outcome. Our accompanying cadaver dissection provides an explanation for proper plate positioning during ORIF of the ulna to reduce the risk of EIP entrapment.

Keywords

entrapment - extensor indicis proprius - open reduction and internal fixation - ulnar shortening osteotomy - distal radioulnar joint

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References

References
1 Schulte LM, Meals CG, Neviaser RJ. Management of adult diaphyseal both-bone forearm fractures. J Am Acad Orthop Surg 2014; 22 (07) 437-446
2 Fulton C, Grewal R, Faber KJ, Roth J, Gan BS. Outcome analysis of ulnar shortening osteotomy for ulnar impaction syndrome. Can J Plast Surg 2012; 20 (01) e1-e5
3 Barbaric K, Rujevcan G, Labas M, Delimar D, Bicanic G. Ulnar shortening osteotomy after distal radius fracture malunion: Review of literature. Open Orthop J 2015; 9 (01) 98-106
4 Yammine K. The prevalence of the extensor indicis tendon and its variants: a systematic review and meta-analysis. Surg Radiol Anat 2015; 37 (03) 247-254
5 Komiyama M, Nwe TM, Toyota N, Shimada Y. Variations of the extensor indicis muscle and tendon. J Hand Surg [Br] 1999; 24 (05) 575-578
6 Ghijselings S, Demuynck M. Delayed rupture of the extensor digitorum tendon of the index finger after a distal radial fracture in a child. J Hand Surg Eur Vol 2013; 38 (01) 85-86
7 Singh HP, Srinivasan S, Ullah A. Closed rupture of the extensor indicis and extensor digitorum tendons to the index finger after locking plate fixation of a fracture of the distal radius. J Hand Surg Eur Vol 2013; 38 (01) 86-87
8 Piotuch B, Puchalski P, Żyluk A. Entrapment of the extensor indicis proprius tendon in the callus after a distal radial fracture. J Hand Surg Eur Vol 2015; 40 (05) 541-542
9 Nagy L, Jungwirth-Weinberger A, Campbell D, Pino JG. The AO ulnar shortening osteotomy system indications and surgical technique. J Wrist Surg 2014; 3 (02) 91-97
10 Doherty C, Gan BS, Grewal R. Ulnar shortening osteotomy for ulnar impaction syndrome. J Wrist Surg 2014; 3 (02) 85-90